Mesurer les caractéristiques organisationnelles des soins de santé

Transcription

Mesurer les caractéristiques organisationnelles
des soins de santé de première ligne : une
étude de repérage des items utilisés dans les
questionnaires internationaux
INSTITUT NATIONAL
DE SANTÉ PUBLIQUE
DU QUÉBEC
Mesurer les caractéristiques organisationnelles
des soins de santé de première ligne : une
étude de repérage des items utilisés dans les
questionnaires internationaux
Unité de l’Évaluation de l’organisation des soins et services
Direction de l’Analyse et de l’évaluation des systèmes de soins et services
Février 2014
AUTEURS
Jean-Frédéric Levesque, directeur scientifique
Institut national de santé publique du Québec
Sarah Descôteaux, agente de planification, de programmation et de recherche,
Nicolas Demers, stagiaire,
Direction de l’Analyse et de l’évaluation des systèmes de soins et services,
Institut national de santé publique du Québec,
Direction de santé publique de l’Agence de la santé et des services sociaux de Montréal
Mike Benigeri, consultant en gestion de l'information sur la santé
MISE EN PAGES
Nancy Robert, agente administrative
Direction de l’analyse et de l’évaluation des systèmes de soins et services
Cette étude a été élaborée pour compléter une suite de trois outils d'enquête évaluant les soins de
santé de première ligne dans le cadre du Projet d’étude des soins de santé de première ligne de
l'ICIS. Elle a été effectuée afin de soutenir l’élaboration d’un questionnaire mesurant les
caractéristiques organisationnelles des soins de santé de première ligne au Canada.
Ce document est disponible intégralement en format électronique (PDF) sur le site Web de l’Institut national de
santé publique du Québec au : http://www.inspq.qc.ca.
Les reproductions à des fins d’étude privée ou de recherche sont autorisées en vertu de l’article 29 de la Loi sur
le droit d’auteur. Toute autre utilisation doit faire l’objet d’une autorisation du gouvernement du Québec qui détient
les droits exclusifs de propriété intellectuelle sur ce document. Cette autorisation peut être obtenue en formulant
une demande au guichet central du Service de la gestion des droits d’auteur des Publications du Québec à l’aide
d’un formulaire en ligne accessible à l’adresse suivante : http://www.droitauteur.gouv.qc.ca/autorisation.php, ou
en écrivant un courriel à : [email protected].
Les données contenues dans le document peuvent être citées, à condition d’en mentionner la source.
e
DÉPÔT LÉGAL – 2 TRIMESTRE 2014
BIBLIOTHÈQUE ET ARCHIVES NATIONALES DU QUÉBEC
BIBLIOTHÈQUE ET ARCHIVES CANADA
ISBN : 978-2-550-70303-7 (PDF)
©Gouvernement du Québec (2014)
Mesurer les caractéristiques organisationnelles des soins de santé de première ligne :
une étude de repérage des items utilisés dans les questionnaires internationaux
REMERCIEMENTS
Cette étude de repérage sur la mesure des caractéristiques organisationnelles des soins de
santé de première ligne n’aurait pas été possible sans le soutien de plusieurs experts dans le
domaine. Tout d’abord, nous tenons à souligner la contribution des experts consultés. Pour
plus de détails sur ces experts, voir l'annexe 3.
Des remerciements doivent aussi être transmis à mesdames Cathie Scott, Audrey Couture
et Jeannie Haggerty, ainsi qu’aux docteurs Sabrina Wong, Raynald Pineault, Bill Hogg,
Sharon Johnston, Alan Katz, Rick Glazier et Fred Burge qui ont commenté certaines
sections de ce rapport ou le questionnaire qui en découle pour identifier les caractéristiques
organisationnelles. Les observations et commentaires de chacun de nos réviseurs ont
grandement contribué aux résultats de ce travail. Leurs apports ont été particulièrement
utiles dans l’élaboration du questionnaire organisationnel.
Nous tenons aussi à remercier tout particulièrement madame Danièle Francoeur pour son
soutien dans l’élaboration de cette étude.
Nous tenons aussi à exprimer notre reconnaissance envers le personnel de l'Institut
canadien d'information sur la santé (ICIS) en particulier Ali Moses McKeag, Brenda Tipper et
Greg Webster pour leur soutien dans le cadre de ce projet.
I
TABLE DES MATIÈRES
1
INTRODUCTION.............................................................................................................1
1.1
1.2
1.3
Contribution des organisations de soins de santé de première ligne au
rendement des systèmes de santé.........................................................................1
Élaboration d’un outil de mesure destiné à l’évaluation des organisations
de soins de santé de première ligne.......................................................................1
Le présent rapport ..................................................................................................2
2
OBJECTIFS DE L’ÉTUDE DE REPÉRAGE ...................................................................3
3
MÉTHODOLOGIE...........................................................................................................5
3.1
3.2
4
RÉSULTATS ..................................................................................................................7
4.1
4.2
5
Définir les caractéristiques organisationnelles ........................................................9
Aperçu de la classification des items compris dans les questionnaires
retenus .................................................................................................................14
DISCUSSION................................................................................................................17
5.1
5.2
6
La recension des outils de mesure .........................................................................5
La classification......................................................................................................6
Caractéristiques organisationnelles couvertes par les questionnaires
retenus .................................................................................................................17
Forces et limites ...................................................................................................19
CONCLUSION ..............................................................................................................21
RÉFÉRENCES .....................................................................................................................23
ANNEXE 1
LES QUESTIONNAIRES ET LES OUTILS RETENUS ................................. 25
ANNEXE 2
CLASSIFICATION DES ITEMS ISSUS DES QUESTIONNAIRES
RETENUS .....................................................................................................35
ANNEXE 3
AUTEURS CONTACTÉS DANS LE CADRE DE L’ÉTUDE DE
REPÉRAGE ................................................................................................131
III
LISTE DES TABLEAUX
Tableau 1
Résultats de l’étude de repérage des questionnaires.......................................7
Tableau 2
Système de classification des caractéristiques organisationnelles des
soins de santé de première ligne ...................................................................11
Tableau 3
Résumé de la couverture des caractéristiques organisationnelles dans les
questionnaires retenus ..................................................................................15
V
LISTE DES SIGLES ET ACRONYMES
CARG
Coronary Artery Bypass Grafting
CHC
Community Health Centre
CHF
Congestive Heart Failure
CMA/MA
Certified Medical Assistant
CME
Continuing Medical Education
COPD
Chronic Obstructive Pulmonary Disease
CSSS
Centre de santé et de services sociaux
DO
Doctor of Osteopathic Medicine
DSL
Digital Subscriber Line
ECG
Electrocardiogram
EHR
Electronic Health Record
EMR
Electronic Medical Record
FFS
Fee-For-Service
FHG
Family Health Group
FHN
Family Health Network
FHO
Family Health Organization
FHT
Family Health Team
FMG
Family Medicine Group
FRNZCGP
Fellow of the Royal New Zealand College of General Practitioners
FTE
Full Time Equivalent
GP
General Practitioner
HEDIS
Healthcare Effectiveness Data and Information Set
HMO
Health Maintenance Organization
HRA
Health Risk Assessment
HSO
Health Service Organization
ICD
International Classification of Diseases
ICPC
International Classification of Primary Care
INSPQ
IPA
Independent Practice Association
LPN
Licensed Practical Nurse
MD
Doctor of Medicine
MI
Myocardial Infarction
MOPS
Maintenance of Professional Standards
VII
NP
Nurse Practitioner
OB/GYN
Obstetrics and Gynecology
PA
Physician Assistant
PC
Personal Computer
PHC
Primary Health Care
PHO
Physician-Hospital Organization
PHS
Public Health Service
PTCA
Per Cutaneous Transluminal Coronary Angioplasty
RAMQ
Régie de l’assurance maladie du Québec
RN
Registred Nurse
STD
Sexually Transmitted Diseases
VIII
1
INTRODUCTION
1.1
CONTRIBUTION DES ORGANISATIONS DE SOINS DE SANTÉ DE PREMIÈRE LIGNE AU
RENDEMENT DES SYSTÈMES DE SANTÉ
Afin d’améliorer l’accès aux soins de santé, les décideurs se sont investis dans la réforme de
l’organisation, du financement et de la prestation des soins de santé de première ligne 1
(Broemeling et collab., 2006; Wong et collab., 2011). Il s’agit d’une orientation qui fait suite
aux recommandations de divers comités provinciaux, ainsi qu’à la publication du rapport de
la Commission Romanow en 2002 (Jaakkimainen 2011). Il est désormais reconnu que les
systèmes axés sur les soins de santé de première ligne améliorent la santé globale des
populations (Starfield et collab., 2005; OMS 2008; Jaakkimainen et collab., 2011). On
s’attend donc à ce que la réforme des organisations de soins de santé de première ligne
permette à la clientèle de ces organisations de vivre une meilleure expérience de soins axée
sur l’accessibilité des services, la continuité, l’efficacité, la sécurité, l’intégralité des soins et
ainsi que sur la réactivité des organisations (Starfield et collab., 2005; OMS 2008; Sutherland
et Coyle 2009).
Il est important de reconnaître qu’au cours des dernières années les organisations de soins
de santé de première ligne au Canada ont, de façon constante, considérablement évolué
(Strumpf et collab., 2012; Hutchison et collab., 2011; Broemeling et collab., 2006). En
matière de prestation de services, les réformes qui ont été mises en place dans toutes les
provinces du Canada ont engendré différents modèles organisationnels de soins de santé de
première ligne (Cook et Kachala 2004; Strumpf et collab., 2012). L’adoption de certains de
ces modèles a eu des répercussions positives sur la qualité des soins de santé (Hutchison et
collab., 2011; Levesque et collab., 2010; Haggerty et collab., 2004; Broemeling et
collab., 2006).
L’évaluation organisationnelle des soins de santé de première ligne est un domaine en
constante évolution qui doit tenir compte de la complexité de l’environnement de chaque
organisation de soins de santé de première ligne. L’étendue et la diversité des réformes
dans ce domaine démontrent l’importance de concevoir des outils standardisés qui
permettent aux chercheurs de recueillir des renseignements pertinents et comparables dans
différents contextes.
1.2
ÉLABORATION D’UN OUTIL DE MESURE DESTINÉ À L’ÉVALUATION DES
ORGANISATIONS DE SOINS DE SANTÉ DE PREMIÈRE LIGNE
L’Institut canadien d’information sur la santé (ICIS) a piloté l’élaboration d’une série de trois
outils de mesure portant sur l’évaluation de l’organisation des soins de santé de première
ligne, les prestataires de soins et les patients. Ces outils sont basés sur les pratiques
organisationnelles. Ils peuvent être utilisés pour mesurer la qualité des soins de santé de
première ligne et évaluer l’organisation et la prestation des soins de santé de première ligne.
La présente étude de repérage fait partie du projet d’étude des soins de santé de première
1
Tout au long de ce document, l’expression « soins de santé de première ligne » comprend également les
services offerts en première ligne.
1
ligne de l’ICIS. Elle a été effectuée dans le but de soutenir l’élaboration du questionnaire
portant sur l’organisation des soins de santé de première ligne. Ce questionnaire devait
permettre d’évaluer l’organisation et la prestation des soins de santé de première ligne
partout au Canada. Jusqu’à présent, « la recherche sur les soins de santé première ligne
menée au Canada n’a pas été pleinement exploitée » (McMurchy 2009).
En lien avec ce constat, la présente étude a pour but de faciliter la recherche sur les soins de
santé de première ligne en exposant la démarche qui a mené à l’élaboration d’un
questionnaire conçu pour mesurer les caractéristiques organisationnelles des soins de santé
de première ligne. Ce questionnaire développé dans le cadre du projet de l’ICIS diffère des
deux autres outils complémentaires qui, eux, évaluent les pratiques liées au prestataire de
services ainsi que l’expérience vécue par le patient. En effet, le questionnaire portant sur les
caractéristiques organisationnelles offre la possibilité d’être adapté de manière à pouvoir être
utilisé dans une grande variété de contextes de soins de santé de première ligne. « La
qualité des soins de santé est un concept aux multiples facettes, et l’évaluation de
nombreuses perspectives différentes est nécessaire pour la mesurer » (Wong et
collab. 2008).
Une meilleure compréhension des caractéristiques organisationnelles de soins de santé de
première ligne est importante pour orienter les réformes à venir et évaluer les répercussions
des innovations implantées dans différents contextes.
« Les pratiques de première ligne, y compris la médecine familiale et, dans
quelques contextes, la médecine interne générale, ainsi que les pratiques
pédiatriques sont uniques parmi les prestataires de soins de santé, en ce sens
qu’elles constituent la porte d’entrée de nombreux patients aux besoins multiples
en matière de soins de santé, de la prévention à l’identification des maladies, en
passant par le traitement des malaises et la référence aux spécialistes »
(Ohman-Strickland et collab. 2007).
1.3
LE PRÉSENT RAPPORT
Cette étude de repérage revêt une certaine importance dans un contexte où il ne se fait que
peu de recherche pour mesurer les caractéristiques organisationnelles des modèles de
prestation des soins de santé de première ligne. Étant donné les changements constants
auxquels font face les organisations de santé de première ligne, cette étude répond à un réel
besoin. Par conséquent, nous avons répertorié les outils de mesure disponibles à l’échelle
internationale, conçu une grille de classification des différentes caractéristiques
organisationnelles mesurées par les outils recensés, classé les items couverts par ces
différents outils et analysé la couverture en fonction des différentes caractéristiques
organisationnelles pour chacun de ces outils. Nous avons ainsi retenu 19 questionnaires
portant sur l’organisation de soins de santé de première ligne. À partir de ces questionnaires,
nous avons créé une base de données complète en classifiant les questions en fonction de
différentes caractéristiques organisationnelles. Les questions les plus pertinentes pour
évaluer l’organisation et la prestation des soins de santé de première ligne ont été
sélectionnées afin de concevoir un questionnaire organisationnel détaillé qui, nous
l’espérons, sera largement adopté, de façon à ce que les travaux effectués par différents
chercheurs puissent être comparés.
2
2
OBJECTIFS DE L’ÉTUDE DE REPÉRAGE
Cette étude a pour but de brosser un portrait global des principaux items repérés dans
différents questionnaires. Les trois principales étapes de cette étude de repérage sont :
1. d’identifier les questionnaires et les outils existants qui mesurent les caractéristiques
organisationnelles des soins de santé de première ligne;
2. d’élaborer un système de classification qui permet de regrouper et d’organiser les
caractéristiques organisationnelles des soins de santé de première ligne à la lumière des
travaux pertinents ayant été effectués dans ce domaine;
3. de classer les questions et les items pertinents dans le système de classification élaboré.
Le but final de l’étude était d’élaborer un questionnaire permettant d’évaluer les
caractéristiques organisationnelles et la prestation des soins de santé de première ligne.
3
3
MÉTHODOLOGIE
3.1
LA RECENSION DES OUTILS DE MESURE
Cette étude de repérage a été basée essentiellement sur une revue de la littérature
scientifique et de la littérature grise ainsi que sur une consultation auprès d’experts. Afin de
repérer les différents questionnaires et outils de mesure qui ont porté sur l’objet de l’étude,
nous avons utilisé les bases de données de PubMed et 360 Search 2.
Les expressions et mots clés ci-dessous ont été utilisés afin de repérer une vaste gamme de
documents :
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Modèles de soins de santé
Soins de santé de première ligne
Études sur les soins de santé
Centres de santé communautaire/Organisation et administration
Études transversales
Accessibilité des services de santé
Modèles organisationnels
Innovation organisationnelle
Soins de santé de première ligne/Organisation et administration
Soins de santé de première ligne/Normes
Questionnaires
Évaluation des résultats et des procédures (soins de santé)/Organisation et administration
Soins axés sur les patients/Organisation et administration
Qualité des soins de santé/Organisation et administration
Une fois cette étape franchie, une méthode de sondage en boule de neige a été utilisée afin
de trouver des outils pertinents supplémentaires. Cette méthode implique la consultation
directe auprès de divers auteurs, puisque la plupart des questionnaires repérés dans les
études extraites des bases de données n’étaient pas publiés. Ainsi, beaucoup d’auteurs 3
nous ont orientés vers la source d’autres outils. À la fin de cette étape de l’étude, la revue de
littérature portait principalement sur du matériel publié ou non à l’échelle nationale ou
internationale. Par la suite, chaque outil de mesure repéré a été révisé afin de s’assurer qu’il
mesurait bien des aspects de l’organisation et de la prestation des soins de santé de
première ligne. De plus, l’outil devait avoir été conçu pour être rempli par le gestionnaire ou
le médecin responsable de l’organisation des soins de santé de première ligne (par
exemple : clinique médicale) ; notre intérêt, rappelons-le, était d’évaluer l’organisation
générale et la prestation des soins de santé plutôt que l’aspect clinique des soins de santé
de première ligne. Enfin, signalons que les questionnaires publiés en langues française et
anglaise ont été pris en considération, que seuls les questionnaires accessibles au grand
public ont été retenus et que trois questionnaires pour lesquels des frais d’accès étaient
2
3
Un outil de métarecherche employé à l’Institut national de santé publique du Québec.
Les auteurs ayant contribué à nos travaux sont mentionnés dans l’annexe 3.
5
exigés ont été rejetés. Au final, 19 questionnaires ont été retenus selon les critères
présentés plus haut.
3.2
LA CLASSIFICATION
Les items de chacun des questionnaires retenus ont été consignés dans un tableau présenté
à l’annexe 2. Un système de classification des caractéristiques organisationnelles des soins
de santé de première ligne a d’abord été élaboré pour faciliter le traitement des items
présents dans chaque questionnaire. Un assistant de recherche a classé les questions et les
items de chacun des 19 questionnaires selon des catégories de caractéristiques
organisationnelles des soins de santé de première ligne (tableau 2). Après cette première
attribution des questions et des items aux catégories, trois observateurs indépendants ont
évalué l’exactitude de cette attribution. Les classements ont été adaptés de façon itérative
jusqu’à l’obtention d’un accord consensuel entre les observateurs.
6
4
RÉSULTATS
Au cours de la revue de la littérature, nous avons trouvé de nombreuses études qui visaient
à évaluer les caractéristiques organisationnelles des soins de santé de première ligne. Au
total, 19 outils ont été retenus parmi ces études et présentés ci-dessous dans le tableau 1 4.
Chacun des questionnaires était présenté sous une forme différente, en fonction des
objectifs de recherche, et variait également selon les caractéristiques organisationnelles
couvertes : ressources humaines, financières, techniques, matérielles, organisation de la
clinique, etc. La plupart des outils retenus ont été conçus pour mesurer certaines
caractéristiques organisationnelles de soins de santé de première ligne, ou encore pour
décrire l’expérience des médecins dans différents types d’organisations de soins de santé de
première ligne. L’évaluation de la qualité des soins fournis aux patients ainsi que le
rendement des organisations de soins de santé de première ligne figuraient également parmi
les thèmes récurrents dans les 19 questionnaires.
Tableau 1
Résultats de l’étude de repérage des questionnaires
Acronyme
Nombre de
formulaires
Nombre
d’items
Répondant
ISPCD
1
40
PS
Europe
Physician Questionnaire
(Evaluating costs and
quality of primary care in
Europe)
QUALICOPC
1
62
PS
Australie
Bettering the Evaluation
And Care of Health
BEACH
1
20
PS
Nouvelle-Zélande
National Primary Medical
Care Survey
NatMedCa
2
42
OSSPL et PS
Royaume-Uni
Improving the delivery of
care for patients with type
2 diabetes
IDCP2D
2
35
Personnel
re
1 ligne et
OSSPL
National Ambulatory
Medical Care Survey
NAMCS
3
77
OSSPL
Primary Care Practice Site
Survey
PCPSS
1
35
OSSPL
Physician Practice and
Quality of Care Survey
PPQCS
1
35
OSSPL
Survey of Organizational
Attributes for Primary Care
SOAPC
1
21
Personnel
re
1 ligne
Origine
Nom de l’étude/Projet
International Survey of
Commonwealth Fund Primary Care Doctors
(2009)
a
États-Unis
a
Indique la source des renseignements recueillis. OSSPL indique que la source est l’organisation de soins de santé de
première ligne, PS indique qu’il s’agit du prestataire de soins.
4
Pour une présentation détaillée des outils de mesure retenus, consultez l’annexe 1.
7
Tableau 1
Résultats de l’étude de repérage des questionnaires (suite)
Origine
Nom de l’étude/Projet
Acronyme
Nombre de
formulaires
Nombre
d’items
Répondant
Methods for evaluating
practice change toward a
patient-centered medical
home
TransforMED
5
273
OSSPL
National Study of
Physician Organizations
and the Management of
Chronic Illness II
NSPOII
2
443
OSSPL
NFPWS 2001
1
52
PS
Sondage national des
médecins
NPS2010
1
39
PS
Comparison of Models of
Primary Health Care in
Ontario
COMP-PC
1
20
OSSPL
Improving Measurement
for Evaluation in Primary
Health Care
IMEPHC
1
20
OSSPL
CPCQ
3
85
OSSPL et PS
Assessing the evolution
of primary healthcare
organizations and their
performance
Évolution
1
65
OSSPL
Clinicians’ perception of
organizational readiness
for change
CPORC
1
36
Personnel
re
1 ligne
PCOS-NS
2
97
OSSPL
États-Unis (suite)
National Family Physician
Workforce Survey
Canada
Ontario (Canada)
Continuity of Primary
Care in Quebec
Québec (Canada)
Nouvelle-Écosse
(Canada)
Primary Care
Organization Survey
Les questionnaires retenus variaient en longueur, soit de 20 à 85 questions généralement et
jusqu’à plus de 250 questions dans le cas de deux questionnaires. Ils variaient également
selon le répondant ciblé : la plupart des questionnaires devaient être remplis par le principal
acteur de l’organisation de soins de santé de première ligne (gestionnaire, médecin ou
infirmière-chef), quelques-uns s’adressaient à plusieurs professionnels de la santé.
Les 19 questionnaires retenus ont tous été conçus pour évaluer des caractéristiques
organisationnelles des soins de santé de première ligne. Les zones géographiques
couvertes par chaque questionnaire variaient également d’une étude à l’autre, soit
internationale 5, nationale 6 ou régionale 7.
5
6
7
8
ISPCD = 11 pays, QUALICOPC = 34 pays.
BEACH, NatMedCa, IDCP2D, NAMCS, TransforMED, NSPOII, NFPWS 2001, et NPS 2010.
SOAPC, PCPSS, PPQCS, Evolution, COMP-PC, IMEPHC, CPCQ, CPORC et PCOS-NS.
Dans la plupart des cas, les questionnaires étaient envoyés en format imprimé aux
répondants et certains étaient disponibles en format électronique. D’autres questionnaires
ont été remplis par entrevue téléphonique. Selon les types de question, différentes modalités
de réponse étaient proposées (échelle de réponses, à développement court ou à choix
multiples) et couvraient à la fois des thèmes spécifiques et généraux. La moitié des
questionnaires sélectionnés ont été utilisés au Canada.
Finalement, certaines études comprenaient un aspect longitudinal et prenaient appui sur une
collecte de données répétée à différents moments de l’étude afin d’obtenir une plus grande
compréhension de l’organisation des soins de santé de première ligne (Évolution : 2005 et
2010; BEACH : tous les ans depuis 1998; NAMCS : annuellement de 1973 à 1981, une fois
en 1985, annuellement depuis 1989; NSPOII : janvier 2000 et juillet 2007; NFPWS 2001 : en
1997 et en 2001; NPS 2010 : en 2004, en 2007 et en 2010).
4.1
DÉFINIR LES CARACTÉRISTIQUES ORGANISATIONNELLES
Dans le cadre de notre étude, nous avons utilisé différents systèmes de classification des
caractéristiques organisationnelles qui ont fait l’objet d’une publication au Canada. Haggerty
et collab. (2007) ont proposé 25 caractéristiques de soins de santé de première ligne à
prendre en considération dans l’évaluation des organisations de soins de santé de première
ligne sur la base d’une consultation auprès d’experts. Ces caractéristiques ont été
regroupées par les auteurs en cinq catégories : les caractéristiques de la pratique clinique,
les dimensions structurelles de la pratique, les éléments axés sur la personne, les éléments
axés sur la communauté et les dimensions liées au rendement du système. Enfin, cinq
caractéristiques spécifiques aux soins de santé de première ligne ont été identifiées et
intégrées dans ce système de classification : accessibilité/premier contact, continuité
relationnelle, soins axés sur la famille, équipe intersectorielle et cheminement de la
population.
Notre travail de définition des caractéristiques organisationnelles a également été inspiré par
Hogg et collab. (2008). Cette équipe a élaboré un cadre conceptuel pour faciliter la mesure
du rendement dans un système de soins de santé de première ligne. Ce cadre conceptuel
renvoie à deux domaines jugés complémentaires : la structure et le rendement.
« Le domaine structurel comprend le système de soins de santé, le contexte de
pratique et l’organisation de la pratique pouvant concerner les activités de toute
organisation de soins de première ligne. Le domaine du rendement comprend les
caractéristiques de la prestation des soins de santé et la qualité des soins
cliniques d’un point de vue technique. » (Hogg et collab. 2008).
Par la suite, nous avons adapté nos premières classifications afin d’inclure les dimensions
présentes dans les questionnaires retenus qui complétaient celles couvertes par les deux
cadres conceptuels mentionnés ci-dessus. Comme certains questionnaires étaient élaborés
en tenant compte des caractéristiques particulières à un contexte de soins de santé de
première ligne, il nous apparaissait important d’en tenir compte dans l’élaboration de notre
système de classification. Par exemple, le questionnaire du projet Évolution (Pineault et
collab. 2012) était basé sur quatre aspects organisationnels utilisés pour décrire les
9
organisations de soins de santé de première ligne : la vision, les ressources, la structure
organisationnelle et les pratiques. La vision renvoie aux croyances, aux valeurs et aux
objectifs partagés par les intervenants. Les ressources réfèrent à la gamme et à la
disponibilité des ressources (humaines et matérielles). La structure organisationnelle renvoie
à la législation, aux règlements et à la gouvernance. Finalement, les pratiques sont
associées à la prestation de services et aux domaines d’application des activités de la
clinique (Levesque et collab. 2010; Lamarche et collab. 2003).
Notre démarche d’identification des différentes caractéristiques organisationnelles nous a
permis de repérer de nombreux concepts utiles pour décrire et évaluer l’organisation, la
prestation de services et le rendement des organisations de soins de santé de première
ligne. Le tableau 2 illustre la classification des caractéristiques organisationnelles identifiées
tout en fournissant une brève définition pour chacune. Au total, notre classification comprend
23 catégories de caractéristiques organisationnelles des soins de santé de première ligne,
réparties en sept sections principales :
•
•
•
•
•
•
•
identification de l’organisation;
vision organisationnelle;
ressources organisationnelles;
structures organisationnelles;
prestation de services et pratiques cliniques;
rendement et résultats organisationnels;
contexte organisationnel.
Le système de classification présenté dans le tableau ci-dessous constitue un des résultats
principaux de notre étude de repérage. Il est le fondement de la classification des items des
questionnaires retenus pour l’analyse que nous présentons plus loin dans ce document.
10
Tableau 2
Système de classification des caractéristiques organisationnelles des soins de santé de première ligne
Section
Identification de
l’organisation
Vision
organisationnelle
Ressources
organisationnelles
Catégorie
Définition
Répondant
Cette catégorie comprend les items liés à l’identification du répondant (nom, sexe, âge, titre/fonction, etc.).
Lieu
Le lieu comprend l’adresse, la ville et le type de milieu de travail.
Historique et
évolution de la
clinique
Les items liés à l’historique et à l’évolution de la clinique, y compris les détails comme l’âge de la clinique et les
facteurs associés à sa croissance et à son développement.
Orientation
L’orientation de la clinique renvoie au système de valeurs et aux idéologies prédominantes qui orientent les actions,
la prise de décisions et les priorités de l’organisation.
Mission
Cette catégorie est liée aux buts et aux objectifs prédominants de la clinique et du personnel à l’égard de leur
travail. Les objectifs spécifiques y sont mis en évidence.
Responsabilité et
imputabilité
Cette catégorie comprend les renseignements sur la responsabilité et l’imputabilité de l’organisation auprès des
institutions professionnelles et des corps gouvernementaux compétents, de même que la santé de la communauté
et le système global de soins de santé.
Ressources
humaines
Cette catégorie comprend les aspects reliés à la composition et à l’implication du personnel de la clinique. Les
détails concernant le nombre de professionnels de la santé, le nombre d’heures travaillées par semaine, de même
que l’âge, le sexe, le milieu de travail et les fonctions occupées par les divers membres du personnel font également
partie des items pris en considération.
Ressources
économiques
Les ressources économiques de la clinique renvoient aux sources et aux montants de financement reçus. Les
détails concernant le budget d’exploitation de la clinique et les dépenses courantes font également partie de cette
catégorie. Signalons que l’information sur la façon dont les ressources économiques sont attribuées dans
l’organisation (par exemple : les mesures incitatives financières) est prise en considération dans la « gouvernance »
et les « mécanismes de financement » présentés plus loin.
Ressources
techniques
Dans cette catégorie, les ressources techniques de l’organisation sont documentées par la disponibilité et l’accès à
différents équipements médicaux (par exemple : salles d’examen, équipement diagnostique) ainsi que par les
technologies de l’information. Les renseignements liés à l’utilisation de ces ressources sont également inclus dans
cette section.
11
Tableau 2
Système de classification des caractéristiques organisationnelles des soins de santé de première ligne (suite)
Section
Catégorie
Définition
Gouvernance et
structure
administrative
Tous les enjeux liés à la gestion sont regroupés dans cette catégorie. La propriété, la structure organisationnelle
verticale et horizontale, les processus de prise de décisions, les politiques administratives et les structures
opérationnelles de la clinique (par exemple : le système de prise de rendez-vous) se retrouvent dans cette
catégorie. Les aspects relatifs au leadership, à l’intégration dans la communauté, plus particulièrement l’implication
du patient et des membres de la communauté dans la planification stratégique des soins de santé, de même que
les autorités organisationnelles, régionales et locales en matière de santé figurent également dans la catégorie de
la gouvernance.
Mécanismes de
financement
Dans cette catégorie se retrouve la description des méthodes utilisées pour répartir les ressources entre les
intervenants, de façon à répondre aux exigences et aux objectifs gouvernementaux. On y retrouve également
l’information sur la rémunération (salaires, honoraires, capitation, contrats, etc.), les mesures incitatives, les
subventions et autres modalités.
Procédures
cliniques
Les procédures cliniques se définissent comme les structures mises en place pour gérer les décisions cliniques.
Les détails concernant la répartition du travail entre les médecins, les mécanismes de prise de décisions cliniques,
les modèles d’organisation des services, de même que les stratégies de partage de l’information, de collaboration,
de coordination et d’intégration (par exemple : les discussions concernant les cas légaux, un guide de pratiques
cliniques, etc.) se retrouvent dans cette catégorie.
Mécanismes
d’amélioration de
la qualité et de la
sécurité du
patient
L’existence de procédures de contrôle et d’amélioration de la qualité, comme l’évaluation des résultats et de la
satisfaction, la formation professionnelle continue, les initiatives d’amélioration de la qualité, l’application de
modèles d’amélioration continue (par exemple : PDSA, LEAN, etc.), de même que les mécanismes mis en place
pour assurer la sécurité du patient (procédures de collecte et de suivi des plaintes, implantation de guide de
pratique, conciliation des médicaments, mécanismes d’imputabilité, etc.), sont des aspects importants de la
structure organisationnelle et sont documentés dans cette catégorie.
Horaires et
heures
d’ouverture
L’accessibilité des soins de santé pendant (et après) les heures d’ouverture de la clinique est abordée ici par la
capacité de la clinique à assurer la disponibilité de professionnels de la santé (services sur rendez-vous et sans
rendez-vous).
Types et gamme
de services
offerts
On retrouve dans cette catégorie une liste exhaustive des services offerts par la clinique. L’objectif de cet exercice
est de brosser le portrait de la diversité et de l’étendue des activités de soins de santé fournis en clinique.
Gestion de
maladies
spécifiques
Cette catégorie comprend les détails au sujet des services fournis pour la prévention, le dépistage et le traitement
de certains types de problèmes particuliers. Des programmes spéciaux, comme ceux portant sur la gestion des
problèmes de santé mentale, de dépendances et d’autres maladies chroniques, sont documentés ici.
Structures
organisationnelles
Prestation de
services et pratiques
cliniques
12
Tableau 2
Système de classification des caractéristiques organisationnelles des soins de santé de première ligne (suite)
Section
Prestation de
services et pratiques
cliniques (suite)
Rendement et
résultats
organisationnels
Contexte
organisationnel
Catégorie
Définition
Degré
d’intégration
Cette catégorie comprend l’importance de l’échange d’information, de la collaboration, de la coordination et de
l’intégralité dans l’adaptation du traitement au patient tout au long des soins qui lui sont prodigués.
« L’échange d’information » renvoie au niveau de communication entre les intervenants tout au long des soins
prodigués au patient.
Le terme « collaboration » renvoie spécifiquement à l’importance du travail d’équipe entre les omnipraticiens, les
spécialistes et les autres professionnels de la santé afin d’offrir des soins optimaux aux patients.
La coordination concerne la prestation et l’organisation d’une combinaison de services et d’information grâce
auxquels les intervenants peuvent répondre aux besoins des patients en matière de santé.
L’« intégralité » est la caractéristique d’une offre de service qui répond à une vaste gamme de besoins des patients
en matière de santé tout au long de leurs expériences de soins.
Accessibilité
La facilité avec laquelle une personne peut commencer à établir un contact et obtenir les soins nécessaires, de
même que les délais qui s’appliquent.
Fonctionnement
et climat
Cette catégorie regroupe les items liés au climat organisationnel en ce qui concerne l’interaction et la satisfaction de
tous les intervenants d’une clinique.
Viabilité et
efficacité
La viabilité d’une clinique se mesure à la capacité de cette dernière à répondre adéquatement à la demande de
services, à l’exploitation de la clinique de façon rentable et au soutien du développement à long terme de la clinique.
Réceptivité au
changement et
capacité
d’adaptation
Cette catégorie regroupe les items liés à la capacité de l’organisation à répondre aux besoins changeants de la
population tout en tenant compte des transitions démographiques, épidémiologiques et sanitaires de la
communauté. L’aptitude de la clinique à répondre adéquatement aux réformes en cours figure également dans cette
catégorie.
Caractéristiques
démographiques
Cette catégorie comprend les détails liés aux caractéristiques de la population et des patients desservis par la
clinique. Une distribution est effectuée en fonction de l’âge, du sexe, du groupe ethnique et des déterminants
spécifiques à la santé de la population. Les statistiques concernant les besoins particuliers en matière de soins de
santé et les questions liées à la santé publique identifiées chez la population et les patients de la clinique font
également partie de cette section.
Environnement
organisationnel et
intégration de la
pratique
L’environnement organisationnel définit le contexte de la clinique. Les items comme la distance entre les
infrastructures de soins de santé, la présence de programmes de santé qui obligent une coordination entre
différentes institutions, la présence d’une faculté de médecine, de même que l’existence de liens officiels ou non
entre les organisations dans la communauté sont inclus dans cette catégorie.
13
4.2
APERÇU DE LA CLASSIFICATION DES ITEMS COMPRIS DANS LES QUESTIONNAIRES
RETENUS
Le tableau 3 montre l’étendue de la couverture des catégories des caractéristiques
organisationnelles des soins de première ligne par les 19 questionnaires retenus dans la
présente étude de repérage. La règle utilisée pour la création du tableau était la suivante :
pour figurer dans une catégorie, le questionnaire devait contenir au moins un item relatif à
cette catégorie. Chaque catégorie contenait au moins un item extrait d’un questionnaire. Sur
les 19 questionnaires retenus, deux questionnaires (CPORC et SOAPC) évaluaient un
maximum de deux caractéristiques organisationnelles. Compte tenu de ses cinq
questionnaires complémentaires, TransforMED est l’outil de mesure qui englobait le plus
grand nombre des caractéristiques organisationnelles de notre système de classification. En
fait, nous avons constaté qu’il couvrait 21 des 23 catégories. Toutefois, le questionnaire
organisationnel du projet Évolution se démarquait du lot, car il permettait d’évaluer 18 des
23 catégories au moyen d’un seul questionnaire.
14
Tableau 3
Résumé de la couverture des caractéristiques organisationnelles dans les questionnaires retenus
QUESTIONNAIRES
BEACH COMP- CPCQ CPORC Évolution IDCP2D IMEPHC ISPCD NAMCS NatMed NFPWS NPS NSPOII PCOS- PCPSS PPQCS Qualicopc SOAPC TransforM
PC
Ca
2001
2010
NS
ED
Identification de l’organisation
Répondant
X
Lieu
X
Historique et évolution de la
clinique
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Vision organisationnelle
X
Orientation
X
Mission
X
X
X
Responsabilité et imputabilité
X
Ressources organisationnelles
Ressources humaines
X
Ressources techniques
X
X
X
X
X
X
X
X
X
X
X
X
X
Ressources économiques
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Structures organisationnelles
Gouvernance et structure
administrative
X
Mécanismes de financement
Procédures cliniques
Mécanismes d’amélioration
de la qualité et de la sécurité
du patient
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Prestation de services et pratiques cliniques
Horaires et heures
d’ouverture
Types et gamme de services
offerts
X
X
X
X
X
X
X
Gestion de maladies
spécifiques
X
Degré d’intégration
X
X
X
X
X
X
X
X
X
X
X
15
Tableau 3
Résumé de la couverture des caractéristiques organisationnelles dans les questionnaires retenus (suite)
QUESTIONNAIRES
BEACH COMP- CPCQ CPORC Évolution IDCP2D IMEPHC ISPCD NAMCS NatMed NFPWS NPS NSPOII PCOS- PCPSS PPQCS Qualicopc SOAPC TransforM
PC
Ca
2001
2010
NS
ED
Rendement et résultats organisationnels
Accessibilité
X
X
X
X
X
Fonctionnement et climat
X
X
X
X
X
X
X
X
X
X
X
Réceptivité au changement
et capacité d’adaptation
X
X
X
X
Viabilité et efficacité
X
X
X
X
X
X
X
Contexte organisationnel
Caractéristiques
démographiques
Environnement
organisationnel et intégration
de la pratique
16
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
5
DISCUSSION
Les résultats de l’étude de repérage des caractéristiques organisationnelles de soins de
santé de première ligne ont démontré à partir du système de classification que nous avons
développé, que certains questionnaires permettaient une plus grande couverture des
caractéristiques organisationnelles que d’autres. Deux outils se démarquent : le
questionnaire du projet Évolution et les questionnaires TransforMED lesquels offrent la plus
grande couverture des caractéristiques organisationnelles des soins de santé de première
ligne proposées dans notre système de classification. Signalons que le questionnaire du
projet Évolution (Pineault et collab. 2012) a constitué une base importante pour la conception
du questionnaire de l’ICIS permettant d’évaluer l’organisation et la prestation des soins de
santé de première ligne, car il s’agit également d’un instrument validé ayant été utilisé à deux
reprises dans la province de Québec.
Dans cette section nous discuterons plus en détail de la proportion des caractéristiques
organisationnelles de soins de santé de première ligne couvertes par les questionnaires
retenus, ainsi que des forces et des limites de notre étude de repérage.
5.1
CARACTÉRISTIQUES ORGANISATIONNELLES COUVERTES PAR LES QUESTIONNAIRES
RETENUS
La figure 1 indique la proportion de caractéristiques organisationnelles des soins de santé de
première ligne couvertes dans chacun des questionnaires classés par items dans notre
étude de repérage. Bien que toutes les caractéristiques présentées dans le cadre de cette
étude puissent servir à l’évaluation de l’organisation et de la prestation des soins de santé de
première ligne, dans les questionnaires retenus certaines caractéristiques étaient plus
présentes que d’autres.
17
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Identification de l’organisation
Vision organisationnelle
Ressources organisationnelles
Structures organisationnelles
Figure 1
Prestation de services et pratiques cliniques
Rendement et résultats organisationnels
Contexte organisationnel
Proportion de caractéristiques organisationnelles couvertes par les
questionnaires
L’accessibilité, les ressources humaines et techniques, la gouvernance et la structure
administrative, de même que l’environnement organisationnel et l’intégration de la pratique
sont des caractéristiques que l’on retrouve dans plus de 70 % des questionnaires retenus.
De plus, les caractéristiques liées aux procédures de soins, comme les gammes de services,
la gestion de maladies spécifiques, l’horaire ainsi que les mécanismes de sécurité, sont
également des caractéristiques couvertes dans la majorité des 19 questionnaires.
Notre travail met également en lumière le fait que la couverture des caractéristiques
organisationnelles des soins de santé de première ligne varie grandement d’un questionnaire
à l’autre. En effet, certains concepts ne sont couverts qu’à moins de 20 % pour l’ensemble
des questionnaires retenus. Des caractéristiques comme l’orientation de la clinique, sa
mission, les mécanismes liés à la responsabilité et à l’imputabilité concernent la culture de
l’organisation, un aspect important pouvant avoir diverses répercussions sur l’organisation
d’une clinique ou sur la prestation des soins auprès de ses patients. La faible proportion de
questions sur les ressources économiques disponibles démontre que cette caractéristique
est peu évaluée par les questionnaires retenus à l’étude. Pourtant, la compréhension des
ressources investies dans une clinique de soins de santé de première ligne est essentielle
afin de bien évaluer son rendement ou son efficience. Par ailleurs, dans le cadre de
l’évaluation de réformes des systèmes de santé, il est essentiel de fournir une
18
compréhension des investissements économiques requis dans les différentes formes
d’organisation de soins de santé de première ligne. Finalement, la viabilité et l’efficacité ainsi
que la réceptivité au changement étaient d’autres aspects moins sondés au moyen des
questionnaires retenus dans notre étude. Le recours à ces types d’items, surtout liés aux
processus dynamiques des organisations, seraient d’une certaine importance pour mieux
comprendre le potentiel de réforme dans l’organisation et la prestation des soins de santé de
première ligne ou d’innovation de la pratique actuelle.
En logeant chaque item contenu dans les questionnaires dans le système de classification
que nous avons préalablement défini, il nous a été possible d’élaborer une importante base
de données. Puisqu’aucun questionnaire ne couvre toutes les caractéristiques
organisationnelles des soins de santé de première ligne, nous sommes persuadés que cette
base de données permettra de réaliser des évaluations de façon plus optimale. Précisons
que les utilisateurs pourront tirer profit cette base de données dans la mesure où leurs
objectifs de recherche ou d’évaluation seront clairs et précis, ce qui orientera leur choix des
items compris dans la base de données.
5.2
FORCES ET LIMITES
Dans l’ensemble, notre étude a permis de repérer de nombreux questionnaires validés
disponibles pour mesurer les caractéristiques organisationnelles des soins de santé de
première ligne. Nous avons également repéré des questionnaires non validés. Dans ces cas,
nous n’avons pas cherché à en évaluer la validité, puisque la majorité de ces questionnaires
comprenait les mêmes questions et concepts que ceux des questionnaires validés retenus
dans notre étude. Toutefois, si les items classés à l'annexe 2 étaient utilisés pour élaborer un
questionnaire, nous recommandons fortement qu’un test cognitif soit effectué au préalable
afin de s’assurer de la compréhension des questions auprès du public cible ainsi que de
l’exactitude des choix de réponses proposés.
Dans notre étude, l’accessibilité et la disponibilité des questionnaires ont constitué un défi à
relever. Malgré tout, grâce à notre démarche méthodologique (revue de la littérature
scientifique et grise ainsi que la méthode en boule de neige), nous croyons avoir été en
mesure de repérer la grande majorité des questionnaires actuellement disponibles
permettant de mesurer les caractéristiques organisationnelles des soins de santé de
première ligne. La méthode en boule de neige a été particulièrement utile, puisque peu de
questionnaires ont fait l’objet de publications scientifiques. Finalement, bien que nous ayons
communiqué avec les experts reconnus en matière d’études organisationnelles sur les soins
de santé de première ligne, nous ne pouvons affirmer que nous avons repéré tous les
questionnaires disponibles et pertinents. Cela dit, notre étude de repérage repose sur une
démarche de collecte et d’analyse des données qui nous a menés à une bonne saturation et
nous croyons avoir ainsi couvert la plus grande partie du domaine.
Dans le cadre de cette étude, notre intention était surtout de cartographier les questionnaires
existants et accessibles qui permettaient de mesurer des caractéristiques organisationnelles
des soins de santé de première ligne et de proposer un ensemble de caractéristiques
organisationnelles considérées comme importantes dans l’évaluation de l’organisation et de
la prestation des soins de santé de première ligne. De plus, signalons que la qualité du
19
contenu des questionnaires ne figurait pas parmi les objectifs de la présente étude, et l’accès
aux données obtenues grâce aux questionnaires aurait été nécessaire pour évaluer la
qualité de certains questionnaires. Il faut souligner que le résumé de notre évaluation de la
couverture des caractéristiques organisationnelles par les questionnaires retenus, et
présenté dans le tableau 3, a reposé sur un critère dichotomique « élément couvert/non
couvert ». Une analyse plus poussée serait nécessaire pour connaître le degré de
couverture de chaque concept compris dans chacun des questionnaires retenus.
Les 19 questionnaires retenus étaient présentés, rappelons-le, sous différentes formes et ont
été utilisés tant au Canada que dans d’autres pays. Bien que tous ces outils soient liés à un
contexte de soins de santé de première ligne, ils ont été principalement utilisés dans des
contextes spécifiques. Pour l’instant, on ne peut donc évaluer la pertinence d’utiliser certains
de ces items dans un contexte canadien. Par exemple, l’outil de mesure TransforMED portait
sur la compréhension de la transformation des pratiques de soins de santé de première ligne
à partir d’une approche d’organisation de soins axés sur le patient et il était orienté vers un
contexte organisationnel précis. Autre exemple, le questionnaire ISPCD, qui compare les
caractéristiques des médecins de première ligne aux États-Unis avec celles des médecins
de dix autres pays, a été utilisé dans le cadre d’une évaluation plus générique de
l’organisation de soins de santé de première ligne.
Finalement, certains questionnaires considéraient l’organisation comme l’unité d’analyse,
tandis que pour d’autres c’était le prestataire de soins en considérant l’organisation comme
un élément de contexte qui influencent le travail de ces prestataires. La grande diversité des
approches d’évaluation sous-jacente à la conception des questionnaires nous incite à faire
preuve de prudence avant de faire le choix des items des divers questionnaires en nous
assurant tout d’abord de leur pertinence en tenant compte des objectifs du projet
d’évaluation et des contextes de l’organisation des soins de santé.
20
6
CONCLUSION
Il est important que les décideurs, les gestionnaires et les prestataires de services de santé
aient accès à des données fiables et comparables générées dans le cadre d’évaluations de
l’organisation et de la prestation des soins de santé de première ligne, et ce au moyen de
questionnaires mesurant adéquatement les caractéristiques organisationnelles des soins de
santé de première ligne.
La définition d’un grand nombre de caractéristiques organisationnelles par les auteurs qui
ont publié dans le domaine, comme l’ont démontré les travaux de Haggerty et collab. (2007),
de Hogg et collab. (2008), ainsi que la présente étude, suggère que la tâche de
conceptualisation des caractéristiques organisationnelles des soins de santé de première
ligne n’est pas simple. En effet, pour effectuer une analyse en profondeur de l’organisation et
de la prestation des soins de santé de première ligne, de nombreuses caractéristiques
doivent être prises en considération. En effet, nous avons vu que certaines caractéristiques
organisationnelles sont moins mesurées, tandis que d’autres figurent dans presque tous les
questionnaires retenus aux fins de cette étude de repérage. Comme l’ont démontré nos
résultats, le questionnaire organisationnel du projet Évolution se démarquait
particulièrement. Il était l’un des rares questionnaires sélectionnés qui avait été conçu en se
basant sur quatre dimensions organisationnelles d’importance : la vision, la structure
organisationnelle, le niveau de ressources et les caractéristiques des pratiques cliniques. Au
moment de l’étude, ce questionnaire avait été utilisé et validé à deux reprises dans le
contexte d’une vaste étude sur les modèles organisationnels et le rendement (2005 et 2010)
dans la province de Québec, au Canada. Le fait que ce questionnaire ait été utilisé dans un
contexte canadien est d’une pertinence particulière pour la présente étude; il a d’ailleurs été
utilisé pour l’élaboration du questionnaire mesurant les caractéristiques organisationnelles
pour le Projet d’étude des soins de santé de première ligne de l’ICIS.
Enfin, rappelons que notre étude avait pour objectif de repérer et de classifier les
questionnaires existants et disponibles, et qu’elle a aussi permis d’atteindre un autre
objectif : fournir une base de données pour le développement de questionnaires utiles dans
le cadre d’une étude mesurant les caractéristiques organisationnelles des soins de santé de
première ligne.
21
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24
ANNEXE 1
LES QUESTIONNAIRES ET LES OUTILS RETENUS
LES QUESTIONNAIRES ET LES OUTILS RETENUS
Nom du questionnaire
Sources / items
Concepts couverts / échelles
Échantillonnage
BEACH: Bettering the Evaluation And Care of Health – AGPSCC (Australia)
a
GP characteristics
20 PS , auto⁻ Caractéristiques du médecin de
administré
questionnaire, 2009-10
famille
20 questions
⁻ Caractéristiques de la clinique
⁻ Utilisation d’outils d’électronique
⁻ Ressources humaines
⁻ Localisation / accessibilité
⁻ Horaire et heures d’ouverture
⁻ Services médicaux
Échantillonnage : Environ 1000 médecins de famille par année
Type : Étude nationale transversale des activités de médecine
générale
Année de collecte : annuellement depuis 1998
Pays : Australie
Résumé : Chaque année environ 1 000 médecins de famille choisis
aléatoirement participent à l’enquête. Chaque médecin de famille doit
détailler 100 consultations consécutives avec des patients sur un
formulaire structuré en format papier qui fournit des informations sur
eux-mêmes et sur leur pratique.
NAMCS: National Ambulatory Medical Care Survey – US Department of Health and Human Services (United States)
Échantillonnage : 4 700 médecins travaillant dans une clinique
Physician Interview
OSSPL, entrevue
⁻ Caractéristiques du médecin de
médicale et 312 prestataires de soins (incluant des professionnels de
Induce Form 2011 (PIIF)
téléphonique
famille
la santé ainsi que des médecins) de centres de santé
46 questions
⁻ Données démographiques des
communautaires (2011)
patients
Type : Étude nationale
Période de collecte : annuellement de 1973 à 1981, à nouveau en
1985, et annuellement depuis 1989.
Community Health Center OSSPL, entrevue
⁻ Type de clinique et localisation
Pays : États-Unis
Induction Interview 2011
téléphonique
⁻ Source de revenus
Résumé : Cette enquête vise à répondre au besoin d’information
(CHCII)
4 questions
⁻ Volume des visites
objective et fiable sur l’offre et l’utilisation de services de soins
Electronic Medical
OSSPL,
médicaux ambulatoires aux États-Unis.
Records Supplement
autoadministré
⁻ Volume des visites
2011 (EMRS)
27 questions
NatMedCa: 2001/02 National Primary Medical Care Survey – Ministry of Health (New Zealand)
Practice Questionnaire
OSSPL,
Échantillonnage : 2802 médecins de famille et infirmières
(Practice Q.)
autoadministré
Type : Étude nationale
25 questions
Période de collecte : en 1991-92
⁻ Services médicaux et les
Pays : Nouvelle Zélande
installations
Résumé : Ce sondage a été effectué pour décrire les soins de santé
de première ligne en Nouvelle-Zélande, y compris les caractéristiques
des prestataires de soins et de leurs cliniques, les patients qui les
Practitioner Questionnaire PS, autoadministré
consultent, les problèmes de santé rencontrés et le soutien offert.
(PQ)
17 questions
famille
⁻ Type de consultations
a
Indique la source des renseignements recueillis. OSSPL indique que la source est l’organisation de services de santé de première ligne, PS indique qu’il s’agit du prestataire de
soins.
27
Sources / items
Échantillonnage
TransforMED: Methods for evaluating practice change toward a patient-centered medical home – Jaén C.R., CRFMPC (United States)
Échantillonnage: Sur 36 cliniques qui ont accepté de participer,
31 cliniques ont terminé l’étude
(ressources humaines,
Type: Étude régionale
gouvernance, fonctionnement et
Collecte: 2006-2008
climat)
Pays: États-Unis
⁻ Caractéristiques démographiques
Résumé: Le projet de recherche vise à comprendre la transformation
des cliniques de soins de santé de première ligne en établissements
famille
de soins centrés sur le patient (les processus de changement, les
⁻ Caractéristiques des nouveaux
résultats de multi-niveaux et contexte).
modèles
Financial Survey (FS)
OSSPL, auto⁻ Ressources économiques
administratré
⁻ Mécanismes de financement
26 questions
⁻ Viabilité et efficacité
Practice Environment
OSSPL, check list
⁻ L’évaluation de l’environnement de
Checklist (PEC)
123 questions
pratique (fonctionnement et climat)
⁻ Sensibilité aux réalités culturelles
⁻ Environnement organisationnel
⁻ Sécurité des patients
⁻ Facteurs de changement au sein
de la pratique de Kotter
⁻ Contenu du modèle de
TransforMED
PCMA Checklist
OSSPL, check list
16 questions
famille
⁻ Dimensions multiples
Vital Self Assessment
OSSPL,
autoadministré
famille
12 questions
QUALICOPC: Physician Questionnaire, Evaluating costs and quality of primary care in Europe – NIVEL (Europe)
Baseline Practice Survey
(BPS)
OSSPL,
autoadministré
96 questions
PS, autoadministré
62 questions
28
(lieu, heures d’ouvertures, etc.)
famille
⁻ Type de rémuneration
⁻ Sécurité des patients et lignes
directrices
Échantillonnage: 220 médecins généralistes dans chaque pays ainsi
que le recrutement de 10 patients pour chacun des médecins
généralistes pour un total d’environ 2200 patients.
Type: Étude internationale
er
er
Période de collecte: du 1 2010 au 1 juin 2013
Lieu: Europe : 36 pays, dont 27 membres de l’Union européenne, en
plus de la Suisse, la Norvège, la Macédoine, l’Islande et la Turquie. À
ces pays s’ajoutent, l’Israël, la Nouvelle-Zélande, l’Australie et le
Canada.
Résumé : La collecte de données aura lieu dans tous les pays au
Sources / items
Échantillonnage
moyen de questionnaires parmi les échantillons de médecins de soins
⁻ Services médicaux et les
de santé de première ligne et de leurs patients. L’étude devrait fournir
installations
une réponse aux questions suivantes : qu’est-ce qu’implique un
système de santé de première ligne solide? Quels sont les effets d’un
⁻ Accessibilité
solide système de soins de première ligne sur la performance globale
⁻ Gestion des maladies spécifiques
d’un système de santé ?
⁻ Satisfaction au travail
ISPCD: 2009 International Survey of Primary Care Doctors – Commonwealth Fund (International)
famille
⁻ Accessibilité
⁻ Équipes et la coordination des
soins
⁻ Mesure de la performance de la
clinique
⁻ Caractéristiques de la clinique et
données démographiques
SOAPC: Survey of Organizational Attributes for Primary Care (United States)
PS, autoadministré
40 questions
Équipe SSP, autoadministré
21 items
⁻
⁻
⁻
⁻
OSSPL,
autoadministré
35 questions
OSSPL,
autoadministré
35 questions
Échantillonnage: plus de 10 000 médecins de soins de santé de
première ligne
Type: Étude internationale
Période de collecte: en 2009
Pays: Australie, Canada, France, Allemagne, Italie, Pays-Bas,
Nouvelle-Zélande, Norvège, Suède, Royaume-Uni et les États-Unis
Résumé: Cette étude a questionné les médecins de soins de
première ligne dans 11 pays afin de comprendre ce qui se passe au
niveau des soins de santé de première ligne.
Échantillonnage: 640 professionnels (cliniciens, infirmières et
personnel de soutien) de 51 cliniques médicales de première ligne
Période de collecte: -Pays: États-Unis (New Jersey et l’est de la Pennsylvanie)
Résumé: Cette étude a pour but de développer un instrument de
mesure d’attributs organisationnels des cliniques de soins de santé de
première ligne et d’évaluer les propriétés de mesure de cet
instrument.
PCPSS/PPQCS: Primary Care Practice Site Survey - Associations Between Structural Capabilities of Primary Care Practices and Performance on
Selected Quality Measures – Friedberg, M. (United States)
Primary Care Practice
Site Survey (PCPSS)
Physician Practice and
Quality of Care Survey
(PPQCS)
Communication
Prise de décision
Stress/chaos
Historique du changement
⁻ Caractéristiques de la clinique,
performance et caracteristiques
⁻ Outils d’amélioration de la qualité
⁻ Autres considerations
Échantillonnage: 305 cliniques
Période de collecte: de mai 2007 à octobre 2007
Pays: États-Unis (Massachusetts)
Résumé: Une étude à propos des capacités structurelles des
cliniques de soins de santé de première ligne, incluant, entre autres,
des questions sur les rappels aux patients, les dossiers médicaux
informatisés, l’accessibilité et la disponibilité.
29
Sources / items
Échantillonnage
NSPOII: National Study of Physician Organizations and the Management of Chronic Illness II – Shortell, S.M. (United States)
Independent Practice
OSSPL, entrevue
Échantillonnage: 538 médecins au sein d’organisations ont completé
Association (IPAs)
téléphonique
l’entrevue
222 questions
Type: Étude nationale
National Survey
⁻ Gestion des soins et la pratique
Questionnaire
Période de collecte: la première collecte a eu lieu de septembre 2000
clinique
à septembre 2001, la seconde de mars 2006 à mars 2007 et, enfin,
Medical Group National
OSSPL, entrevue
Survey Questionnaire
téléphonique
⁻ Soins préventifs et promotion de la d’octobre 2011 jusqu’en 2012.
Pays: États-Unis
221 questions
santé
Résumé: Cette enquête vise à évaluer l’état des processus de
⁻ Culture organisationnelle
prestation des soins et l’utilisation de services préventifs ainsi que
leurs déterminants et la mesure dans laquelle ces facteurs ont changé
au fil du temps.
IDCP2D: Improving the delivery of care for patients with type 2 diabetes – Shortell, S.M. (United Kingdom)
Questionnaire –
Background & Section 1
Équipe SSP, autoadministré (10-15
minutes)
10 questions
OSSPL, entrevue
téléphonique
25 questions
⁻ Caractéristiques de l’équipe SSP
PS, autoadministré
39 questions
famille
⁻ Accessibilité – Données
démographiques
⁻ Répartition du temps
⁻ Modifications apportées à votre
pratique
⁻ Satisfaction professionnelle
⁻ Gestion des maladies spécifiques
Échantillonnage: Personnel clinique et non-clinique au sein de 100
cliniques de médecine générale.
Période de collecte: -Pays: Royaume Uni
Organisational Structure
Résumé: Le but de cette étude est d’améliorer la qualité des soins
(Telephone interview
aux patients diabétiques pris en charge par les soins de santé de
schedule(TIS))
⁻ Processus cliniques
première ligne en identifiant les facteurs individuels, d’équipe et
⁻ Services médicaux
organisationnels qui permettent de prévoir la mise en place des
meilleures pratiques.
NPS 2010: Sondage national des médecins – Le collège des médecins de famille du Canada (Canada)
30
Échantillonnage: 12,076 médecins ont répondu au questionnaire
Période de collecte: une fois en 2004, puis en 2007 et en 2010
Pays: Canada
Résumé: Le Sondage national des médecins est mené tous les trois
ans afin de capter l’évolution de la profession, la façon dont elle
répond aux besoins de la société et les intérêts personnels et
professionnels de ses membres actuels et futurs.
Sources / items
Échantillonnage
NFPWS 2001 : National Family Physician Workforce Survey – Le collège des médecins de famille du Canada (Canada)
Échantillonnage: 14,319 médecins de famille ont répondu au
questionnaire
famille
⁻ Caractéristiques de la clinique Période de collecte: une fois en 1997/98 et ensuite en 2001
données démographiques
Pays: Canada
⁻ Répartition du temps
Résumé: Le NFPWS 2001 s’appuie sur la base de données originale
en recueillant de l’information qui permettra de faire des
⁻ Accessibilité
comparaisons directes de l’évolution des modes de pratique des
⁻ Modifications apportées à votre
médecins de famielle depuis 1997 et d’explorer de nouveaux
pratique
domaines d’intérêt. L’enquête a tenté de produire un profil détaillé des
modalités d’exercice des médecins de famille aux quatre coins du
⁻ Vie familiale / personnelle
pays.
⁻ Éducation / formation
COMP-PC: Comparison of Models of Primary Health Care in Ontario – Hogg, W. (Ontario - Canada)
PS, autoadministré
52 questions
Practice Survey
OSSPL,
autoadministré
20 questions
⁻
⁻
⁻
⁻
Practice Survey
OSSPL,
autoadministré
20 questions
⁻
⁻
⁻
⁻
⁻
⁻
Échantillonnage: L’étude a recruté 137 cliniques. Ils ont recueilli 363
questionnaires auprès des prestataires de soins.
Période de collecte: entre 2004 et 2006
Pays: Canada (Ontario)
Résumé: Les objectifs de l’étude COMP-PC étaient de décrire quatre
modèles de financement des organisations de santé en Ontario, de
mesurer et comparer la qualité des soins de santé de première ligne
dispensés et de mieux comprendre les aspects organisationnels des
cliniques susceptibles d’influencer l’expérience de soins des patients
et la qualité des soins qu’ils reçoivent.
IMEPHC: Beyond Financial and Work Satisfaction: Improving Measurement for Evaluation in Primary Health Care - Institute for Clinical Evaluative
Science (Ontario - Canada) Green M. & Hogg W.
Caractéristiques de la clinique
Questions générales
Processus cliniques
Mécanismes de financement
Caractéristiques de la clinique
Contexte médicale
Processus cliniques
Ressources humaines
Assurance de la qualité
Structure et le fonctionnement de
l’équipe
⁻ Accessibilité
Échantillonnage: N/A
Période de collecte: N/A
Pays: Canada (Ontario)
Résumé: Ce projet explorera les façons différentes d’acquérir des
données sur les soins de santé de première ligne (questionnaires
auprès des patients, auprès des prestataires de soins, auprès des
cliniques, d’audit des dossiers) et examinera la validité, l’utilité et la
facilité d’application de chaque outil dans le cadre de la participation
des cliniques d’équipes Santé familiale.
31
Sources / items
Échantillonnage
CPCQ: Continuity of Primary Care in Quebec – Haggerty, J. (Québec - Canada)
Clinic organization
questionnaire
OSSPL,
autoadministré
14 questions
PS, autoadministré
60 questions
OSSPL,
autoadministré (30
minutes)
65 questions
⁻ Resources and organisational
structure
⁻ Services, pratiques et
collaborations
interorganisationnelles
⁻ Réorganisation des services SSP
Échantillonnage: 221 médecins issus de 100 cliniques privées et
centre local de services communautaires (CLSC), ont participé à
l’étude.
Année de collecte: en 2002
Pays: Canada (Québec)
Résumé: Cette étude examine l’état de l’accessibilité, la continuité et
la coordination des soins de santé de première ligne en 2002, à l’aube
de la réorganisation du système de santé de première ligne du
Québec.
famille
⁻ Caractéristiques de la clinique données démographiques
⁻ Appartenance à la profession et à
la clinique
⁻ Participation du personnel à la
gestion de la clinique
⁻ Culture de la clinique
Clinic functioning
Liste à cocher
⁻ Fonctionnement de la clinique
11 questions
L’Évolution de l’organisation et de la performance des services de première ligne (2005-2010) dans deux régions du Québec : Montréal et Montérégie)
– Levesque, JFL. (Québec - Canada)
Provider questionnaire
Organisationnal
Questionnaire
32
Échantillonnage: 376 organisations de soins de santé de première
ligne en 2010 et 472 en 2005
Période de collecte: en 2005 et en 2010
Résumé: L’objectif principal de l’étude était d’identifier les modèles
d’organisation de soins de santé de première ligne les mieux adaptés
et les plus prometteurs pour répondre aux besoins et les attentes de
la population.
Sources / items
Échantillonnage
PCOS-NS: Primary Care Organization Survey – Department of Health (Nova Scotia - Canada)
Primary Care
OSSPL, autoÉchantillonnage: S.O.
Organization Survey
administré (30
⁻ Informations sur l’organisation des Type: Étude régionale
minutes)
Période de collecte: -SSP
23 questions
Pays: Canada (Nouvelle-Écosse)
⁻ Planification des services de SSP
Résumé: Le but de l’enquête est d’évaluer les divers aspects des
⁻ Mécanismes d’imputabilité
soins de santé de première ligne y compris l’accès aux programmes
⁻ Collaboration
et services, les types de programmes et de services, la planification,
⁻ Processus d’amélioration de la
les mécanismes de reddition de compte, la collaboration, les initiatives
qualité
d’amélioration de qualité, les politiques et procédures
⁻ Politiques et procédures
organisationnelles et les technologies de l’information et de
organisationnelles
⁻ Technologies de l’information et de communication.
la communication
Primary Health Care
OSSPL,
Provider/Team Survey
autoadministré (20
⁻ Informations démographiques du
minutes)
prestataire de soins
74 questions
⁻ Collaboration et continuité des
soins
⁻ Perfectionnement professionnel fonctionnement d’équipe
⁻ Satisfaction générale au travail
CPORC: Clinicians’ perception of organizational readiness for change in the context of clinical information system project : insights from two crosssectional surveys – Paré, G. (Québec - Canada)
Équipe SSP,
⁻ La réceptivité au changement et la Échantillonnage: Étude 1 : 138 infirmières ont rempli le questionnaire.
autoadministré
Étude 2 : 235 questionnaires (207 cliniciens et 28 médecins) ont été
capacité d’adaptation
36 items
remplis.
⁻ Historique organisationnel du
changement
Période de collecte: en 2007-2008
⁻ Politique et conflits
organisationnels
Résumé: L’objectif principal de cette étude était d’étudier les variables
⁻ Flexibilité organisationnelle
associées à la réceptivité au changement organisationnel des
⁻ Auto-efficacité de groupe
cliniciens dans le contexte spécifique de mise en place de systèmes
d’information clinique.
33
ANNEXE 2
CLASSIFICATION DES ITEMS ISSUS
DES QUESTIONNAIRES RETENUS
Cette annexe présente les questions se rapportant aux attributs organisationnels des soins de santé de première ligne, retrouvés
dans les questionnaires et outils qui ont été retenus. Les questions sont regroupées en fonction de la classification présentée dans la
Section 4 du présent document.
1
IDENTIFICATION DE L’ORGANISATION
1.1
RÉPONDANT
Cette catégorie comprend les éléments liés à l’identification du répondant (nom, sexe, âge, titre/fonction, etc.).
Section/
Questions ou items
question #
Identification de l’organisation / Répondant / Nom
TransforMED Q3
Name of person completing survey:
FS
NSPOII
Name:
TransforMED Application,
Who participated in completing this application form? (List all names and roles)
BPS
Q91
Questionnaire
TransforMED BPS
Application,
Q92
Échelles de réponse
Who in your practice has been involved in making the decision to apply, and how
was it decided to apply?
Identification de l’organisation / Répondant / Sexe
BEACH - GP
Q1
Sex (Please circle.)
o Male / o Female
NAMCS - PIIF
S1 - Q32b
What is your sex?
o Male / o Female
NATMEDCA PQ
Q2
Gender
o Male / o Female
Background,
Q1
Practice
Profile and
Demographi
c Data - Q37
Are you …?
o Male / o Female
SA, Q3
You are:
o Male / o Female
IDCP2D
ISPCD
NPS2010
Identification de l’organisation / Répondant / Âge
BEACH - GP
Q2
Age
NATMEDCA Q1
Age at last birthday (years)
PQ
NAMCS - PIIF
S1 - Q32a
What is your year of birth?
NPS2010
SA, Q2
Your year of birth:
________
19__
19__
37
Questionnaire
Section/
question #
Questions ou items
ISPCD
Practice
Profile and
Demographi
c Data - Q36
How old are you?
o Under 35 / o 35-49 / o 50-64 / o 65 or older
Identification de l’organisation / Répondant / Ethnicité
NAMCS - PIIF
S1 - Q7c
What is your ethnicity?
o Hispanic or Latino / o Not Hispanic or Latino
NAMCS - PIIF
S1 - Q7d
What is your race? (Mark (x) one or more.)
o White / o Black/African-American / o Asian / o Native
Hawaiian / Other Pacific Islander
Identification de l’organisation / Répondant / Diplôme, qualifications ou poste
NAMCS - PIIF
S1 - Q32h
What year did you graduate medical school?
BEACH - GP
NATMEDCA PQ
NATMEDCA PQ
NAMCS - PIIF
Q3
How many years have you spent in general practice?
Q4
How many years in this practice?
Q5
Total years in General Practice
S1 - Q32i
Did you graduate from foreign medical school?
BEACH - GP
Q4
Country of graduation (primary medical degree)
NATMEDCA PQ
Q9
Where did you obtain your medical degree?
NAMCS - PIIF
S1 - Q32c
What is your higest medical degree?
TransforMED BPS
Application,
Q93
What is your (person completing this form) position in the practice? (Check all
that apply.)
IDCP2D
Background,
Q5
What is your role within your General Practice?
NSPOII
NPS2010
38
______ Year
o Yes / o No
o New-Zealand / o Australia / o United Kingdom / o Asia / o
North America /
o Other (Specify)___________
o Doctor of Medicine (MD) / o Doctor of Osteopathic
Medicine (DO) / o Nurse Practitioner / o Physician Assistant
/ o Nurse Midwife / o Other
Position of the respondent (e.g., President, Medical Director, etc.):
If you fall into any of the following categories, please check the appropriate
category and return this UNCOMPLETED questionnaire in the enclosed stamped,
self-addressed envelope.
o Front Office / o Back Office (e.g. billing) / o Office
Manager / o Nurse / o Medical Assistant / o Physician
o Practice nurse / o Nurse Specialist (Specialty
:……………) / o Nurse Practitioner / o Nurse Prescriber / o
District Nurse / o General Practitioner (GP) (Salaried) / o
GP (Partner) / o Other (please specify)…………………..
o I am a medical student / o I am completely retired / o I am
a resident / o I am exclusively working in a non-medical
field. Please specify:
Questionnaire
Section/
question #
NPS2010
NPS2010
SA, Q1
TransforMED BPS
Practice
Staffing
Demographi
cs, Q19
COMP-PC
S1 / 2 / 3
Évolution
Questions ou items
Everyone else, please check ALL that apply to your current situation
o I am in full-time medical practice.
o I am in part-time medical practice or semi-retired from the
medical labour force.
o I am a locum tenens. (If you do not have a permanent
practice, complete the questionnaire in relation to last
practice you served/are currently serving.)
o I am employed in a medical or medically related field only
or other non-clinical settings (e.g., administration, teaching,
research)
o I am on a leave of absence or sabbatical from active
patient care. (Complete the questionnaire in relation to your
most recent medical practice.)
o I have a faculty appointment.
o I have a formal hospital appointment.
o Other, please specify:
Which of these best describes you? (Please check only ONE.)
o Family physician/general practitioner / o Family
physician/general practitioner with a special focus to my
practice, please specify: / o Medical/surgical/laboratory
specialist, please specify: / o Physician working exclusively
as a physician in a non-clinical setting, please specify: / o
Other, please specify:
Identify the main physician contact for the practice's involvement in the
TransforMED NDP:
Please indicate who answered the questions in Section I / II / III. (Please check.)
Position:
Name:
Specialty:
Direct Phone Number:
Email:
Board certification:
Total years in practice:
o Office Manager/Receptionist / o Lead Physician / o Other
Physician / o Nurse Practitioner / o Nurse / o Finance
Manager/Accountant
o Team leader/Medical director / o Head doctor/Physician in
charge /
o Member of the team of general practitioners / o Other,
Specify: __________
NSPOII
SA, Q1a
Do you own or manage a medical group?
IDCP2D
Background,
Q3
Are you a GP trainer in a vocational training scheme?
o Yes / o No
Q6
Post Graduate Qualifications
o M/FRNZCGP / o Overseas M/FRNZCGP equivalent / o
Dip Obs / o Dip Anaesth / o Other (specify) __________
Q7
Are you a member of the New Zealand Medical Association?
o Yes / o No
NATMEDCA PQ
NATMEDCA PQ
o Yes / o No
39
1.2
LIEU
Le lieu comprend l’adresse, la ville et le type de milieu de travail.
Section/
question #
Identification de l’organisation / Lieu
TransforMED - FS
Q2
PPQCS
NSPOII
BEACH - GP
Q15
Practice
TransforMED - BPS
Information, Q53
Questionnaire
TransforMED - BPS
Practice
Demographics,
Q1
NPS2010
SB, Q5
BEACH - GP
Q14
NPS2010
SB, Q6
CPCQ
Practice Profile,
Q1
40
SD, Q3
Practice Name:
What is the name of your primary practice site?
Name of Physician Organization:
In which GP Division is this practice?
If your practice has other office sites, please indicate how many
Enter the following information about the PRACTICE:
Address, this will also be the address where we will send the check to
:
NSPOII
Evolution
Questions ou items
Practice name:
Address:
City:
State:
Zip:
Email:
Phone:
Fax:
Web site:
City:
State:
Zip:
Phone Number:
Fax Number:
Email:
In which province(s)/territory(ies) do you currently work? (Check all
that apply).
Postcode of major practice address
Please provide the 6-digit postal code of your MAIN patient care
setting OR main work setting:
Please provide the 6-digit postal code of your practice location:
Where is your clinic located?
o In a building owned by the physicians or of which they
are shareholders / o In rented offices in a commercial
building for health professionals / o In rented office in a
commercial building for any type of business / o In an
establishment that is part of the publicly-funded health
netwer (hospital, CLSC, etc.) / o Others (Specify:
______________)
1.3
HISTORIQUE ET ÉVOLUTION DE LA CLINIQUE
Éléments liés à l’historique et à l’évolution de la clinique, y compris les détails comme l’âge de la clinique et les facteurs associés à
sa croissance et à son développement.
Section/
Questions ou items
question #
Identification de l’organisation / Historique et évolution de la clinique / Âge de la clinique
Practice
Number of years has this practice been in existence.
TransforMED Demographics, If a not yet established practice, please indicate the date when you
BPS
Q2
anticipate the practice to begin.
IMEPHC
S1, Q1
How long has this practice been in operation?
Questionnaire
Evolution
SD, Q1
How long has your clinic been in operation?
Evolution
SD, Q2
How long has your clinic been at this current location?
NSPOII
SA,Q11
COMP-PC
S1, Q1
COMP-PC
S1, Q3
For approximately how many years has your IPA (Independent Practice
Association) been in existence?
How long has this practice been in operation?
How long has this practice been an FFS (Fee-For-Service)/HSO (Health
Service Organization)/FHN (Family Health Network)?
How long has this practice been a FHT (Family Health Team)?
________ Years
o Less than 1 year / o 1 to 4 years / o 5 to 9 years / o Over 10
years
o Less than 1 year / o 1 to 4 years / o 5 to 9 years / o Over 10
years
________ Years
________ Years
________ Years
________ Years
o Family Health Network (FHN) / o Fee-For-Service (FFS) / o
What model did the practice belong to before, and when did the transition
IMEPHC
S1, Q2
Family Health Group (FHG) / o Family Health Organization (FHO)
take place?
/ o Community Health Centre (CHC) / o Other Specify: _______
Date of transition
(DD/MM/YR)
Identification de l’organisation / Historique et évolution de la clinique / Changements au sein du personnel de la clinique
S - Practice
TransforMED Staffing
Describe any planned or proposed changes to the number of clinicians on
BPS
Demographics, staff at this practice.
Q22
S - Practice
Describe any planned or proposed changes to the number of office staff
BPS
Demographics, (non physician, medical or administrative).
Q29
S - Practice
How many have left the practice within the last year?
Clinicians:_____
BPS
Demographics,
Staff:_________
Q30
S - Practice
How many have joined the practice within the last year?
Clinicians:_____
BPS
Demographics,
Staff:_________
Q31
41
Questionnaire
Section/
question #
Questions ou items
TransforMED FS
Q9
Have any clinicians left or joined the practice during the 12 months?
o Yes / o No
If yes, please specify how many, whether they left or joined, and
which type of clinician. _________
Evolution
SE, Q1
PPQCS
Q21ab
Since 2005, has there been any change in the medical staff of your clinic?
If yes, how many doctors joined in? How many left?
a. In the past year, has there been a change in the number of staff at your
practice site?
b. If YES, what was the change in the number of…
i. Physicians
ii. Non-physician clinicians
iii. Administrative staff
How many staff members have left your practice in the past 12 months/ How
many of these have been replaced?
• GPs (partners) / • GPs (salaried) / • Nurses (employed) / • Nurses
(attached) / • Administrative staff
Since this practice has been in operation (as an Fee-For-Service (FFS)/
Health Service Organization (HSO)/ Family Health Network (FHN)),
approximately how many physicians have departed or joined? a. Departed
b. Joined
Since this practice has been in operation (as an Fee-For-Service (FFS)/
Health Service Organization (HSO)/ Family Health Network (FHN)),
approximately how many nurse practitioners have departed or joined? a.
Departed b. Joined
IDCP2D - TIS
S - Structure,
Q13
COMP-PC
S2, Q1
COMP-PC
S2, Q2
ISPCD
Practice Profile
and
Demographic
Data - Q34
Do you plan to leave your medical practice within the next 5 years?
S1, Q12
Over the NEXT 12 months:
Do you have any plans to leave your current position/move to new position?
o Yes / o No
a. o Yes / o No / Don't know
b. o Decrease / o Increase / o No change
………left
………replaced
o None / o 1 to 3 / o 4 to 10 / o More than 10 / o Not Sure/ Don’t
Know
o None / o 1 to 3 / o 4 to 10 / o More than 10 / o Not Sure/ Don’t
Know
o Yes, retiring / o Yes, leaving for other reasons / o No / o Not
Sure
o Yes / o No
IDCP2D
If Yes – it would be helpful to us to know your reason for leaving
……………………………………………
Identification de l’organisation / Historique et évolution de la clinique / Changements de propriété de la clinique
S - Practice
TransforMED Information,
Has there been a change in ownership in the past 12 months?
o Yes / o No
BPS
Q50
S - Practice
Is there a planned change of ownership in the next 12 months?
o Yes / o No
BPS
Q51
Identification de l’organisation / Historique et évolution de la clinique / Changements généraux dans la clinique
S - Practice
Has your practice moved to a new office in the last 12 months?
o Yes / o No
BPS
Q52
S - Changes in
o Relocated practice within the same province? / o Relocated
29. During the past two years, have you (please check all that apply):
NFPWS2001
Practice, Q29practice to another province in Canada? / o Relocated to Canada
30. Please describe the reason(s) for the change(s) you have made:_______
30
from another country? / o Moved from an urban/suburban to a
42
Questionnaire
NFPWS2001
Section/
question #
S - Changes in
Practice, Q3132
Questions ou items
31. Thinking about the next two years, do you plan to (please check all that
apply):
32. Please describe the reason(s) for the change(s) you are planning:______
Evolution
SE, Q2
Evolution
SE, Q3
In your clinic, how have the following activities evolved since 2005?
• Scope of clinical activities
• Number of worked hours by doctors
• Number of walk-in patients seen
• Medical services offered on weekends
In your clinic, to what extent have the following elements changed since
2005?
• Working conditions for staff in your clinic
• Administrative support in your clinic
• Clinical practice support for general practitioners in your clinic
• Quality of care delivered to patients
• Access to lab/imaging facility (“plateau technique”)
• Possibility of having one or several nurses in your clinic
• Collaboration between the clinic and other PHC in your territory
• Ease by which your patients can be seen by specialists
• Collaboration between the clinic and the Health and social service centre
(CSSS)
• Collaboration between your clinic and hospitals outside the Health and
social service centre (CSSS)
• Possibility of recruiting new GP's
• Teamwork among professionals from your clinic
• Access to information technologies
rural/remote practice setting? / o Moved from a rural/remote to an
urban/suburban practice setting? / o Specialized practice within
an area of family medicine (e.g., psychotherapy, palliative care)?
Please specify: / o Reduced scope of practice (e.g., stopped OB,
emergency and/or palliative care)? Please specify: / o Expanded
scope of practice (e.g., added OB, emergency and/or palliative
care)? Please specify: / o Reduced or increased weekly work
hours? Please specify how many hours less or more per week: /
o Other change(s). Please specify: / o Made no significant
change to practice?
o Continue current practice at same location? / o Relocate
practice within the province where you are currently practicing? /
o Relocate practice to another province in Canada? Please
indicate province: / o Leave Canada to practise in another
country? Please indicate country: / o Move from an
urban/suburban to a rural/remote practice setting? / o Move from
a rural/remote to an urban/suburban practice setting? / o
Specialize practice within an area of family medicine (e.g.,
psychotherapy, palliative care)? Please specify: / o
Reduce/expand scope of practice (e.g., stop OB, emergency
and/or palliative care)? Please specify: / o Reduce or increase
weekly work hours? Please specify how many hours less/more
per week: / o Leave active practice for other reasons? Please
specify: / o Make other change(s) to practice? Please specify:
o Have increased / o No change / o Have Decreased
o Improved / o No change / o Deteriorated
43
Questionnaire
Section/
question #
SOAPC
S - History of
change, Q1921
Questions ou items
• Level of financial resources available for the clinic
44
19. Our practice has changed in how it takes initiative to improve patient care
20. Our practice has changed in how it does business
21. Our practice has changed in how everyone relates
Please indicate how strongly you agree or disagree with each
statement.
o Strongly disagree / o Disagree / o Neutral / o Agree / o Strongly
Agree
2.
VISION ORGANISATIONNELLE
2.1
ORIENTATION
L’orientation de la clinique renvoie au système de valeurs et aux idéologies prédominantes qui orientent les actions, la prise de
décisions et les priorités de l’organisation.
Section/
Questions ou items
question #
Vision organisationnelle / Orientation
Questionnaire
a)
b)
TransforMED BPS
S - Practice
Staffing
Demographics,
Q35
Practice character (Please distribute 100 points)a
c)
d)
a)
b)
TransforMED BPS
S - Practice
Staffing
Demographics,
Q36
Practice’s Leaders (please distribute 100 points)2
c)
d)
a)
TransforMED BPS
a
S - Practice
Staffing
Demographics,
Q37
Practice Cohesion (Please distribute 100 points)2
b)
Practice Organization A is a very personal place. It is
a lot like an extended family. People seem to share a
lot of themselves. ____%
Practice Organization B is a very dynamic and
entrepreneurial place. People are willing to stick their
necks out and take risk. ____%
Practice Organization C is a very formalized and
structured place. Procedures generally govern what
people do. ____%
Practice Organization D is a very production oriented
place. A major concern is with getting the job done
and meeting targets. ____%
Leaders in Practice Organization A are warm and
caring – They seek to develop employees’ full
potential and act as their ment0rs or guides. ___%
Leaders in Practice Organization B are risk takers.
They encourage everyone to take risks and be
innovative._______%
Leaders in Practice Organization C are rule enforcers.
They expect employees to follow established rules,
policies, and procedures._______%
Leaders in Practice Organization D are coordinators
and coaches. They help everyone moot the practice’s
goals and objectives. _____%
The glue that holds Practice Organization A together
is loyalty and tradition. Commitment to this practice
runs high. _______%
The glue that holds Practice Organization B together
is commitment to innovation and development. There
is an emphasis on being first._______%
The following question relates to the type of practice that your organization is most like. Each of these items contains four descriptions of practice. Please distribute 100 points
among the four descriptions depending on how similar the description is to your practice. None of the descriptions is any better than the others they are just different. For each
question, please use all 100 points. If a description does not fit your practice at all, please enter “0” rather than leaving a blank. For example, in the question below, if hypothetical
Practice A seems somewhat similar to mine, B seems somewhat similar, and C and D do not seems similar at all, I might enter “70” points for A, “30” points for B, “0” points for C,
and “0”points for D.
45
Questionnaire
Section/
question #
Questions ou items
c)
TransforMED BPS
S - Practice
Staffing
Demographics,
Q38
Practice Emphases (Please distribute 100 points)2
Evolution
SC, Q1
Which statement BEST represents the population that your clinic tries to serve?
(Check one only.)
Evolution
SC, Q2
Evolution
SC, Q5a
Evolution
SC, Q5b
46
Using the scale, indicate how important the following goals are for your clinic:
(Circle your answer choice.)
• Accessibility of services offered by the clinic
• Continuous relationship with patients
• Services that meet patients’ physical, psychological and social needs
• Delivery of preventive and health promotion services
• Services that conform to established guidelines
• Respect, courtesy and confidentiality
• Equity in health care service delivery and absence of discrimination towards
individuals
• Improvement of population health
Choose the statement that corresponds best to your clinic’s vision in relation to:
Responsibility for health. (Check one only.)
Right to services.
(Check one only.)
The glue that holds Practice Organization C together
is formal rules and policies. Maintaining a smooth
running operation is important here._______%
d) The glue that holds Practice Organization D together
is an emphasis on tasks and goal accomplishment. A
production orientation is commonly shared._______%
a) Practice Organization A emphasizes human
resources. High cohesion and morale in the
organization is important._______%
b) Practice Organization B emphasizes growth and
acquiring new resources. Readiness to meet new
challenges is important._______%
c) Practice Organization C emphasizes permanence
and stability. Efficient, smooth operations are
important._______%
d) Practice Organization D emphasizes competitive
actions and achievement. Measurable goals are
important._______%
o Anyone who needs services and shows up at the clinic
o Regular clinic patients or patients registered at the clinic
o The population in the neighbourhood, village or territory
served by the clinic
Less important
1 2 3
4
5
6
7
8
More important
9 10
o Health is an individual responsibility (it is up to each
individual to maintain his or her health or do that it takes to
improve his or her health).
o Health is a collective responsibility (It is up to society to
create conditions that help maintain or improve health).
o Access to care is an absolute right (everyone should
have the same access to health care, based on need,
regardless of financial ability to pay).
o Access to care is a relative right (everyone should have
access to health care but people who can afford it could
pay for better access to health care).
Questionnaire
Evolution
Section/
question #
SC, Q5c
Questions ou items
Responsibility / role of physician.
(Check one only.)
o The physician is principally a health expert who makes
an accurate diagnosis and identifies the most effective
treatment for the patient’s disease.
o The physician is principally a health enabler who uses
his/her competence to partner with the patient to take more
control over health within the context of the patient’s needs
and personal life circumstance.
47
2.2
MISSION
Cette catégorie est liée aux buts et aux objectifs prédominants de la clinique et du personnel dans leur travail. Les objectifs
spécifiques sont ici mis en évidence.
Section/
Questions ou items
question #
Vision Organisationnelle / Mission
To what extent does your group practice emphasize the following (or, if you
are in solo practice, to what extent do you emphasize the following):
• Handling urgencies or emergencies for our regular patients.
• Handling urgencies or emergencies for walk-in patients.
• That our practice is first and foremost a business.
• Being able to see newly ill patients within 1 day.
• Managing chronic illness.
S - Practice • Doing prevention.
• Attending to psychosocial needs of patients.
CPCQ
Culture,
• Offering patients the most up-to-date drugs and procedures.
Q16
• Knowing the needs of the community where our practice is located.
• Keeping on schedule.
• Having good relationships with specialists to facilitate referrals.
• Cost-effectiveness as a criterion for use of low-volume, high cost
diagnostic procedures such as CT scans.
• Maintaining phone access to MDs for patients.
• Offering in-hospital follow-up for regular patients of the clinic’s MDs.
Do you totally agree, partly agree, partly disagree or totally disagree with
the following statements:
• Physicians see the clinic as a business for which financial return is
important.
Evolution
SC, Q3
• Clinic physicians should consider environmental or occupational causes
when assessing patients’ health problems.
• Clinic physicians should consider social problems in their clinical
interventions for patients (e.g. poverty, violence, substance dependence).
Do you totally agree, partly agree, partly disagree or totally disagree with
the following statements (or doesn’t apply because only 1 doctor in the
clinic):
Evolution
SC, Q4
• Clinic professionals share the clinic’s mission, values and objectives.
• It is important for the clinic’s general practitioners to work as a team.
Choose the one statement that corresponds best to your clinic’s priorities
Evolution
SC, Q6
regarding service organization. (Check one only).
Questionnaire
Evolution
48
SC, Q7
Choose the one statement that corresponds best to your clinic’s preferred
approach for obtaining desired health outcomes for your patients. (Check
one only).
Not at all
1
2
3
To a very great extent
4
5
o Totally agree / o Partly agree / o Partly disagree / o Totally
disagree
o Totally agree / o Partly agree / o Partly disagree / o Totally
disagree / o Doesn’t apply because only 1 doctor in the clinic
o Service accessibility is a higher priority.
o Continuity of care for patients is a higher priority.
o Rather the application of evidence-based medicine and clinical
guidelines.
o Rather the participation and empowerment of the patient and his
family.
2.3
RESPONSABILITÉ ET IMPUTABILITÉ
Cette catégorie comprend les renseignements sur la responsabilité et l’imputabilité de l’organisation auprès des institutions
professionnelles et des corps gouvernementaux compétents, de même que la santé de la communauté et le système global de soins
de santé.
Questionnaire
Section/
question #
Questions ou items
Vision organisationnelle / Responsabilité et imputabilité
QUALICOPC
S - Community
responsibility,
Q58
Evolution
SA, Q7
Evolution
SA, Q8
If you were confronted with the following among your patients, would you report
this (for instance to an authority)?
a) Repeated accidents at a factory.
b) Frequent respiratory problems in patients living near a factory.
c) Repeated cases of food poisoning among people living in a certain district.
To what extent do general practitioners at your clinic feel responsible for the
health of the population in the neighbourhood, village or territory where your clinic
is located?
To what extent do general practitioners at your clinic feel accountable for their
professional activities to…
a) The Régie de l’assurance maladie du Québec (RAMQ)?
b) The Collège des médecins?
c) Colleagues at work?
d) Governance/clinic managers?
o Yes / o Probably yes / o Probably not / o No / o Don’t
know
o Highly / o Fairly / o Slightly / o Not at all
o Highly / o Fairly / o Slightly / o Not at all / o Doesn’t apply
because only one doctor in the clinic
49
3.
RESSOURCES ORGANISATIONNELLES
3.1
RESSOURCES HUMAINES
La catégorie des ressources humaines comprend les aspects reliés à la composition et à l’implication du personnel de la clinique.
Les détails concernant le nombre de professionnels de la santé, le nombre d’heures travaillées par semaine, de même que l’âge, le
sexe, le milieu de travail et les fonctions occupées par les divers membres du personnel font également partie des éléments pris en
considération.
Section/
Questions ou items
question #
Ressources organisationnelles / Ressources humaines / Taille ou composition des équipes de professionnels de la santé
1. It is mainly primary care physicians. [please consider
primary care physicians to include family practitioners,
Which ONE of the following three statements best describes your Independent
general internists, general practitioners, and general
Practice Association (IPA)?
pediatricians]
NSPOII
SA, Q8
2. It is a multispecialty IPA that includes both specialists
If response is 3: What is the main specialty in your IPA?
and primary care physicians.
3. It is mainly non-primary care specialists
• Individual General Practitioners (including yourself)?
• Full time equivalent General Practitioners (including
For this practice, please specify the number of...
yourself)?
BEACH - GP
Q16
• Individual Practice Nurses?
(Full time equivalent (FTE) = 35-45 hrs/wk)
• Full time equivalent Practice Nurses?
How many mid-level providers (i.e., nurse practitioners, physician assistants, and
NAMCS - PIIF
S2 - Q18d
nurse midwives) are associated with you?
Please indicate the number of FTE workers in the following categories:
S -Mix of
• Manager / •Reception staff / • Administrative staff / •
NATMEDCA (Please use Full Time Equivalents e.g. 0.5 = 2.5 days/week; when one person
personnel,
Doctor / • Nurse / • Community worker / • Midwife / • Other
Practice Q.
performs more than one role, please estimate amount of time for each. Rough
Q13
(Specify) :______
data is better than none at all!)
S -Mix of
• New Zealand European / • Maori / • Samoan / • Cook
NATMEDCA Please indicate the number of staff according to the following ethnicity
personnel,
Island Maori / • Tongan / • Niuean / • Chinese / • Indian / •
Practice Q.
categories
Q14
Other
S - Practice
Please complete the following regarding the number of clinicians in your practice
Full-Time:_______
and their FTEs (Full Time Equivalent):
Part-Time: ______
BPS
Demographics, • Doctor of Medicine (MD) / • Doctor of Osteopathic Medicine (DO) / • Nurse
Total FTE: ______
Q21
Practitioner (NP) / • Physician Assistant (PA) / • Other Clinician(s)
Please complete the following regarding the number of staff in your practice and
their FTEs:
S - Practice
• Registered Nurse (RN) / • Licensed Practical Nurse (LPN) / • Medical Assistant
Full-Time:_______
Staffing
TransforMED (CMA/MA)/ • Clerks / Receptionists / Billing / • Medical Records Technician / •
Part-Time: ______
Demographics,
BPS
Information Technology Technician / • Social Worker / Financial Counselor / •
Total FTE: _______
Q26
Dietician
Allied Health Staff (Lab, X-ray, EKG tech, physician therapist) / • Practice
Questionnaire
50
Questionnaire
Section/
question #
Questions ou items
Manager / • Patient Educators / • Other
TransforMED FS
Q15-Q18
Please provide your best estimate of current staffing. (FTE = Full Time
Equivalent).
QUALICOPC
S - Practice
staff, Q20
Do you work alone or in shared accommodation with one or more GPs and/or
medical specialists? Please also fill in their number of FTEs (Full Time
Equivalents).
Total Physicians FTE’s ___________
Total Nurse Practitioners FTE’S ___________
Total Physicians Assistants FTE’s __________
Total Other Staff FTE’s_______________
• Alone
• With other GPs in shared accommodation, namely __
GPs (fill in number), counting for ___ FTE
• With medical specialist(s) in shared accommodation,
namely __ specialists (fill in number), counting for ___ FTE
• With both GPs and medical specialists in shared
accommodation; their total number is: __ (fill in number),
counting for ___ FTE
Which of the following disciplines are working in your practice/centre?
QUALICOPC
S - Practice
staff, Q21
PCPSS
Q16
PCPSS
Q17
PCPSS
Q20 a, b
PCPSS
Q19
NSPOII
SA, Q2
NSPOII - MG
SA, Q7
• Receptionist/med. secretary / • Practice nurse / • Assistant for laboratory work /
• Manager of the centre or practice (not a physician) / • Community / home care
nurse / • Psychiatric nurse / • Midwife / • Physiotherapist / • Dentist / • Pharmacist
/ • Social worker
In a typical day,
• How many physicians (including OB/GYNs) at your practice site provide
primary care?
• How many of these physicians are taking new patients?
• How many of these physician are OB/Gyn?
During a typical day, how many non-physicians clinical staff are engaged in
patient care at your practice site?
a. How many specialist physicians provide specialty services at your practice site
(excluding OB/GYNs)?
b. What specialty services do they provide?
During a typical day, how many administrative staff (e.g., managers,
receptionists, billing coordinators, medical records personnel) are present at
your practice site?
At the present point in time, approximately what is the total number of physicians
practicing in your IPA across all its locations? (Please count both full and parttime.)
If you indicated that your medical group owns an IPA, approximately what is the
total number of physicians (both full-time and part-time) practicing in your owned
IPA, IF (UNSURE: Please give me your best estimate.)
o Yes / o No / o Don’t know "
_____ = number of Nurse Practitioners (NPs) and
Physician Assistant (PA)s
_____ = number of Registered Nurses (RNs) and Licensed
Practical Nurses (LPNs)
_____ = number of Medical Assistants
_____ = number of Pharmacists
_____ = number of Social Workers or Counselors
_____ = number of Nutritionists
_____ = other staff: __________________
Total number of physicians __________
Total number of physicians __________
51
Questionnaire
Section/
question #
Questions ou items
Are there any other health professionals attached to (or employed by) your
practice?
o Yes / o No
Name__________
Role__________
No of sessions __________
IDCP2D - TIS
S - Structure,
Q11
a. If yes, note:
• Type of HP: Chiropodist, Psychologist, Healthcare assistant, Midwife, etc.
• Number of sessions:
• Nature of attachment – what they do, who employed by:
IDCP2D - TIS
S - Structure,
Q12
How many administration staff (managerial, clerical, reception) do you have in
your practice?
NFPWS2001
S-Practice
Setting, Q4
Please indicate the NUMBER of each type of health care provider in your MAIN
practice setting.
(Please count yourself.)
COMP-PC
S1, Q9
CPCQ
S - Practice
profile, Q5
Evolution
SA, Q1.a
Evolution
SA, Q1.c
Evolution
SA, Q1.d
Evolution
SA, Q1.e
Evolution
SA, Q3
S - Practice
Staffing
Demographics,
Q20
S - Practice
Demographics,
Q4
TransforMED BPS
TransforMED BPS
IDCP2D - TIS
52
S - Structure,
Q10
Name__________
Role__________
No of sessions __________
• Family Physicians / • Registered Nurses (other than
nurse practitioners) / • Psychologists / • Specialist
Physicians / • Other Nurses (e.g., registered / licensed
practical nurses) / • Occupational Therapists / • Nurse
Practitioners / • Dieticians / Nutritionists / •
Physiotherapists / • Others. Please specify:
Does your practice site hire physicians to work on a contractual basis? (Please
check one.)
o Yes / o No
If Yes, how many full-time-equivalent (FTE) physicians per week?
How many on a sporadic basis?
__________FTE
__________
Please indicate the NUMBER of each type of personnel that works in this
practice setting:
Receptionists / • Medical or Administrative Secretaries / •
Secretary-Receptionist / • Janitorial Staff / • Clerical staff / •
Other Please specify: _____
How many general practitioners, including those working part time, currently
work at your clinic?
How many of these are in the following age categories?
How many of these are:
• 34 and less / • 35 to 49 / • 50 to 64 / • 65 and more
Women: ________
Men: ________
How many of these general practitioners have been working at your clinic for
more than 5 years?
How many nurses currently work at your clinic?
Describe the physicians in your practice.
• Degree:
• Years in Practice:
• Specialty:
• Board Certification:
Which clinical specialties are represented in this practice? (Choose all that
apply.)
o Family Medicine / o Internal Medicine / o Pediatrics / o
OB/GYN / o Other (please specify) ________
How many nurses do you have in your practice? ……………….
How many are employed by the practice?
Name / How many sessions are covered by this Nurse?
How many are attached to the practice? (District nurses,
etc.):
Name / How many sessions are covered by this Nurse?
Questionnaire
Section/
question #
Questions ou items
NSPOII
SA,Q13
Approximately what proportion of the physicians in your IPA is board-certified?
Do not include board-eligible. (IF UNSURE: Please give your best estimate.)
__________ %
ISPCD
ISPCD
Practice Profile
and
Demographic
Data - Q29
Practice Profile
and
Demographic
Data - Q28
IMEPHC
S11, Q1
IDCP2D - TIS
S - Structure,
Q9
How many non-physician FTE health care providers (nurses, therapists or other
clinicians) are in your practice?
How many full time equivalent (FTE) doctors, including yourself, are in your
practice?
For each participating Family Physician or Nurse Practitioner, please indicate the
following: (Please list each of the participating Family Physicians or Nurse
Practitioners)
How many GPs do you have in your practice? ……………….
Organizational Resources / Ressources humaines / Heures de travail
How many direct patient care hours do you work per week? (include hours of
BEACH - GP
Q5
direct patient care, instructions, counselling, etc. and other services such as
referrals, prescriptions, phone calls, etc.)
During the last normal week of practice, how many hours of direct patient care
NAMCS - PIIF
S2 - Q19a
did you provide?
NATMEDCA How many hours per month do you spend on Continuing Medical Education
Q8
PQ
(CME) / Maintenance of Professional Standards (MOPS)?
NATMEDCA Q14
Number of half days worked per week
PQ
Practice Profile
and
Thinking about your medical practice, about how many hours a week do you
ISPCD
Demographic
typically work? (Your best estimate will do.)
Data - Q30
CPCQ
S - Practice
profile, Q4
Please provide the following information for each type of health care provider in
this practice setting.
Type of health care provider
• GPs / • Specialists (MDs), specify / • Nurses / • Assistant nurses / •
Psychologists / • Occupational therapists / • Physiotherapists / • Dietetician / •
Others, specify :
Evolution
SA, Q1.b
Indicate how many general practitioners in the following categories work at your
clinic.
How many are partners?
Name / How many sessions are covered by this Dr?
How many are salaried?
Name / How many sessions are covered by this Dr?
______ hours
- Number
- Present at the clinic
• Days / week
• Hours / week
- Relationship with family doctors
• Referrals from GPs to providers (Y/N)
• Referals from providers to GPs (Y/N)
• Formal exchange of information about results of
evaluations or treatments
• Less than 10 hours a week? _______
• 10 to 25 hours a week?__________
• 26 to 40 hours a week?_______
• More than 40 hours a week?_______
53
Section/
Questions ou items
question #
Ressources organisationnelles / Ressources humaines / Rôle des professionnels de la santé
Questionnaire
o Patient triage (none, some, and a lot) / o Patient
telephone advice / o Medication refills / o Health behavior
counselling / o Chronic disease management / o Medical
history taking / o Immunizations by protocol / o Patient
follow-up
o Patient triage / o Patient telephone advice / o Medication
refills / o Health behavior counselling / o Chronic disease
management / o Medical history taking / o Immunizations
by protocol / o Patient follow-up
TransforMED BPS
S - Practice
Staffing
Demographics,
Q27
Please indicate the involvement of your practice's MEDICAL
ASSISTANTS (CMA/MA) in the following activities:
(Check all that apply.)
TransforMED BPS
S - Practice
Staffing
Demographics,
Q28
Please indicate the involvement of your practice's NURSES (RN or LPN) in the
following activities.
QUALICOPC
SCollaboration,
Q46
Does your practice nurse independently provide:
• Immunisation
• Health promotion (e.g. giving lifestyle advice)
• Routine checks of chronically ill patients (e.g. diabetes)
• Minor procedures (e.g. ear syringing, wound treatment)
o Not applicable (No nurse in my practice) / o Yes / o No
ISPCD
Teams and
Care
Coordination Q10
Other than doctors, does your practice include any other health care providers
(e.g., nurses, nurse practitioners, physician assistants, medical assistants, or
pharmacists) who share responsibility for managing patient care?
o Yes / o No
Teams and
Care
Coordination Q11
IF YES: Do any of these other staff help manage patient care in the following
ways?
a. Call patients to check on medications, symptoms, or help coordinate care inbetween visits
b. Execute standing orders for medication refills, ordering tests, and delivering
routine preventive services
c. Educate patients about managing their own care
d. Counsel patients on exercise, nutrition and how to stay healthy
o Yes, routinely / o Yes, occasionally / o No
What are the roles and functions of the nurses on your medical team? (Check all
that apply.)
o There’s no nurse on the medical team
o Triage of walk-in patients
o Counseling on tobacco use, diet and physical activity
o Health education (e.g. blood glucose testing, blood
pressure measurement)
o Follow-up of specific clienteles
o Sexually transmitted and blood borne infections (STBI)
counseling
o Liaison and coordination with CLSC, LTCF, hospitals and
other clinics
o Support for medical activities (blood pressure, weight,
injections, etc.)
o Participation in clinical decisions
o Conducting clinical activities as part of a collective
prescription
ISPCD
Evolution
54
SB, Q21
Section/
Questions ou items
question #
Ressources organisationnelles / Ressources humaines / Disponibilité des professionnels de la santé
Questionnaire
NPS2010
SC, Q12
Are there any barriers that currently exist to prevent you from engaging a
Physician / Clinical Assistant or Nurse Practitioner in your practice? (Check all
that apply.)
• Physician / Clinical Assistants
• Nurse Practitioners
o Lack of information about them
o They have not been introduced in my jurisdiction yet
o Liability is not clearly defined
o Regulatory framework does not permit me to delegate to
them
o Limited funding models
o My practice would not benefit from them
o Other, please specify: “
CPCQ
S - Practice
profile, Q6
How difficult is it for this clinic to find MDs, nurses and support staff to provide
services according to the following schedule:
• MDs / • Nurses / • Support staff
o Monday to friday, 9AM-5PM / o Monday to friday, 5PM9PM / o Saturday / o Sunday
55
3.2
RESSOURCES ÉCONOMIQUES
Les ressources économiques de la clinique sont documentées en ce qui a trait aux sources et aux montants de financement reçus.
Les détails concernant le budget d’exploitation de la clinique et les dépenses courantes font également partie de cette catégorie.
L’information sur la façon dont les ressources économiques sont attribuées dans l’organisation (par exemple : les mesures incitatives
financières) est prise en considération dans la « gouvernance » et les « mécanismes de financement ».
Section/
Questions ou items
question #
Ressources organisationnelles / Ressources économiques / Coûts d’opérations
S - Practice
What is the practice's net revenue per physician per year (net revenue =
TransforMED - BPS
characteristic
revenue after expenses)? (Please provide a numerical response.)
s, Q54
Please give your best estimate on the average monthly gross revenues for the
TransforMED - FS
Q20
practice? (In US Dollars$; example “2,000,000.00)
Please give your best estimate on the Average monthly pay roll? This includes
TransforMED - FS
Q21
all physicians and all staff. (In US Dollars$; example “2,000,000.00)
Please give your best estimate on the OTHER (not payroll) monthly expenses
TransforMED - FS
Q22
(e.g. rent or mortgage, phone, utilities, supplies, maintenance, fees, etc.)? (In
US Dollars$)
TransforMED - FS
Q23
Average annual Physician salaries. (In US Dollars$)
TransforMED - FS
Q24
Average annual Nurse Practitioner salaries. (In US Dollars$)
TransforMED - FS
Q25
Average annual Physician Assistant salaries. (In US Dollars$)
Questionnaire
COMP-PC
Physicians
•
Family Physicians / Specialist Physicians /
Pediatricians
Other Professional
•
Nurse Practitioners / Registered Practical Nurses /
Nurses / Nursing Assistant / Dieticians/Nutritionists /
Pharmacists / Occupational Therapists /
Physiotherapists / Chiropractors / Chiropodist /
Technicians/Technologists / Midwives / Psychologists
/ Community Health Workers / Social Workers /
Others: (refer to list below) :
Please indicate the staffing level for the most recent year (Please specify fiscal
or calendar year.)
COMP-PC
56
S3
S3
•
•
# Full Time Equivalents (FTEs)
Average Wage/ Hour/ Person($)
Please indicate the operations cost for the most recent year (Please specify
(case aides, child care/preschool teacher, child welfare
worker, community developer, counselor, cultural interpreter,
lawyer, legal aid, outreach/counselor worker, outreach
worker, parent educators, practical assistants, recreation
worker, service access coordinator, speech/language,
pathologist, trained peer worker and welfare worker,
acupuncturist, health promoter/educator, alternative,
complementary therapist, home care worker, hypnotist,
massage therapist, student/trainee and traditional healer)
Administrative personnel
Office Manager / Receptionists / Other Administrative
Personnel / Others, please specify (e.g. volunteers):
Physician Benefits (excluding salaries) (Includes Health
Questionnaire
Section/
question #
Questions ou items
fiscal or calendar year).
Benefits, Life Insurance, Pension, Relief, Professional
Development, etc)
Salaries and Benefits of all personnel other than
Physicians (Includes, Salaries, Health Benefits, Life
Insurance, Pension, Relief, Professional Development,
etc)
Program Operating Costs (Includes Recruitment, Office
Supplies, Postage and Courier, Print/Photocopying,
Resource Material, Translation, Travel, etc)
Administrative Operating Costs (Includes Legal and Audit,
Computer, Meeting Expenses, Interest and Bank Charges,
Data Management, Parking Expense, Social Fund
Expense, etc)
Building and Maintenance Expenses (Includes Acquisition
of Furniture and Equipment, Answering Service,
Equipment Rent/Repair/Maintenance, Computer,
Insurance, Repair and Maintenance, Janitorial Expense,
Refuse and Snow Removal, Security, Maintenance, Staff
Room Expense, etc)
Utilities (Includes Water, Electricity, Gas, Telephone, etc)
Capital Costs. Expected depreciation of capital assets
during one year (i.e. amount by which the current capital
assets will be de-valued over a one year period)
Miscellaneous Expenses
TOTAL EXPENDITURES
If you prefer, instead of filling out the following section, you may attach a copy
of the practice’s year end financial statement. Project staff will extract the
necessary information then shred the financial statement.
Note that all responses will remain strictly anonymous. No information will be
released that would allow identification of an individual respondent or a
particular practice site. All information will be kept strictly confidential. The
pooled answers will inform policy makers in the evaluation of primary health
care with the aim of improving health services in Ontario.
57
3.3
RESSOURCES TECHNIQUES
Les ressources techniques de l’organisation sont documentées ici en termes de disponibilité et du nombre d’équipement médical
(par exemple : salles d’examen, équipement diagnostique) et de technologies de l’information. Les renseignements liés à l’utilisation
de ces ressources sont également inclus dans cette section.
Section/
Questions ou items
question #
Ressources organisationnelles / Ressources techniques / Équipement médical
Does the practice have the following equipment on site?
NATMEDCA S -Equipment,
• ECG machine / • Equipment for intubation / • X-ray facilities / • Autoclave / •
Practice Q.
Q12
Baby Scale / • Liquid Nitrogen / • Defibrillator / • Cautery Machine / • Proctoscope
Questionnaire
QUALICOPC
S- Equipment
in the practice,
Q27
Please tick the equipment used in your practice by yourself or your staff:
S - Practice
Characteristics,
If the lab is located within your practice, indicate the level of complexity:
Q45
Ressources organisationnelles / Ressources techniques / Accès à Internet
S -New Model
TransforMED Characteristics,
What percentage of clinicians have access to the Internet in the office?
BPS
Q86
S -New Model
TransforMED If your practice is connected to the Internet, what method does your practice use
Characteristics,
BPS
for this access?
Q85
S -New Model
What percentage of non-clinicians have access to the Internet in the office?
BPS
Q87
TransforMED BPS
58
o Yes / o No
Laboratory
o Hemoglobinometer / o Any blood glucose test set / o
Any cholesterol meter /o Blood cell counter
Imaging
o Ophthalmoscope / o Proctoscope / o Otoscope / o
Gastroscope / o Sigmoidoscope / o X
/o
‐ray
Ultrasound for abdomen / o Fetus / o Microscope
Functions
o Audiometer / o Bicycle ergometer / o Eye tonometer /
o Peak flow meter / o Spirograph / o Electrocardiograph
/ o Blood pressure meter / o TENS (transcutaneous
electrical nerve stimulation) / o Infusion set / o Doctor’s
bag for emergencies and home visits
Other
o Urine catheter / o Coagulometer / o Set for minor
surgery / o Suture set / o Defibrillator / Resuscitation
equipment / o Disposable syringes / o Disposable
gloves / o Refrigerator for medicines
o Walved / o Provider performed microscopy lab / o
Moderate complexity / o High complexity lab / o No lab
in practice
o Dial-up (modem) / o High-Speed cable / o DSL / o T-1
line or better / o No internet / o Other (please specify)
_____
Section/
Questions ou items
question #
Ressources organisationnelles / Ressources techniques / Dossiers médicaux informatisés (DMI) - Dossiers informatisés de santé (DIS)
Does your practice use an electronic medical record (EMR) or electronic health
o Yes, all electronic / o Yes, part paper and part
NAMCS - PIIF
S2 - Q21a
record (EHR) system? (Do not include billing records systems.)
electronic / o No / o Unknown
NAMCS - PIIF
S2 - Q21b
Which year did your practice install the EMR/EHR system?
_____ Year
At your practice, are there plans for installing a new EMR/EHR system within the
NAMCS - PIIF
S2 - Q22
o Yes / o No / o Maybe / o Unknown
next 18 month?
o Allscripts / o Cerner / o CHARTCARE / o
eClinicalWorks / o Epic / o eMDs / o GE/Centricity / o
What is the name of your current EMR/EHR system?
Greenway Medical / o MED3000 / o NextGen / o Sage /
NAMCS - EMRS
Q17b
o SOAPware / o Practice Fusion / o Other_______ / o
(Mark (X) only one box.)
Unkown
S -New Model
TransforMED o Currently use / o Considering using / o Previously
Characteristics,
An electronic health record
BPS
used / o If currently utilizing an EHR, which one? _____
Q72
S -New Model
If you do not use EHR in your practice, please explain why
BPS
Q73
S - Medical
o ICPC / o ICD-9 / o ICD-10 / o Other / o Not
QUALICOPC
record keeping,
Which clinical classification system are you using for your medical records?
applicable(I don’t use a computer for my medical
Q39
records)
Office systems
and information
Do you use electronic patient medical records in your practice (not including
o Yes / o No
ISPCD
technology billing systems)?
Q15
Ressources organisationnelles / Ressources techniques / Utilisation des outils informatisés - fonctionnalités
o Not at all / o Prescribing / o Internet / o Email
To what extent do YOU use computer at work?
Pathology
(Circle all that apply.)
o Electronic ordering (online) / o Print/produce orders
only / o Electronic results receipt
BEACH - GP
Q11
Medical records
What clinical software is used?
o Complete (paperless) / o Partial/hybrid / o Paper only /
(Please specify.)
o Imaging/other tests
o Yes, all electronic / o Yes, part paper and part
NAMCS - PIIF
S2 - Q20
Does your practice submit claims electronically (electronic billing)?
electronic / o No / o Unknown
o Prescribing practitioner / o Other clinician (including
Registered Nurse) / o Lab technician / o Administrative
At your practice, if orders for prescriptions or lab tests are submitted
NAMCS - PIIF
S2 - Q24
personnel / o Other / o Prescriptions and lab tests
electronically, who submits them?
orders not submitted electronically / o Unknown
o Yes, with a stand-alone practice management system
Do you or your staff verify an individual patient's insurance eligibility
NAMCS - EMRS
Q16
/ o Yes, with an EMR/EHR system / o Yes, using
electronically, with results returned immediatly?
another electronic system / o No / o Unknown
Questionnaire
59
Questionnaire
Section/
question #
NAMCS - EMRS
Q19
NATMEDCA Practice Q.
S - Information
systems, Q22
TransforMED BPS
S -New Model
Characteristics,
Q69
Questions ou items
Please Indicate whether the reporting location has each of the computerized
capabilities listed below. CHECK NO MORE THAN ONE BOX PER ROW. Does
your practice have a computerized system for:
a. Recording patient history and demographic information?
a1. If yes, does this include a patient problem list?
b. Recording clinical notes?
b1. If yes, do they include a comprehensive list of the patient’s medications and
allergies?
c. Ordering prescriptions?
c1. If yes, are prescriptions sent electronically to the pharmacy?
c2. If yes, are warnings of drug interactions or contraindications provided?
d. Providing reminders for guideline-based interventions or screening tests?
e. Ordering lab tests?
e1. If yes, are orders sent electronically?
f. Providing standard order sets related to a particular condition or procedure?
g. Viewing lab results?
g1. If yes, are results incorporated into EMR/EHR?
h. Viewing imaging results?
i. Viewing data on quality of care measures?
j. Electronic reporting to immunization registries?
k. Public health reporting?
k1. If yes, are notifiable diseases sent electronically?
l. Providing patients with clinical summaries for each visit?
m. Exchanging secure messages with patients?
Please indicate which of the following information systems are used by the
practice?
• Computerised age/sex register / • Computerised patient records / • Familybased records / • Computerised disease register / • Computer-based recall
system(s)
Please indicate below additional information about the technology use of your
practice:
• Electronic billing system / • Electronic medical records / • Computer-based
physician order-entry / • PDAs (Personal Digital Assistant) / • Online literature
searching (Medline, Ovid, Medscape, etc.) / • Internet-based knowledge base
(WebMD, Mayo Clinic, etc.)
o Yes / o Yes, but turned off or not used / o No / o
Unknown
o Yes / o No
o Yes / o No
If yes, has your practice changed these in the past year?
TransforMED BPS
TransforMED BPS
60
S -New Model
Characteristics,
Q76
S -New Model
Characteristics,
Q80
Electronic prescribing
o Currently use / o Considering using / o Previously
used / o If an Electronic prescribing is utilized, which
one? _____
Use of clinical practice guidelines and decision support software
used
Questionnaire
Section/
question #
Questions ou items
TransforMED BPS
S -New Model
Characteristics,
Q83
What functions do computers serve for your practice?
(Fill all that apply.)
TransforMED PCMHC
S - Health
Information
Technology, Q9
Are you taking advantage of these e-prescribing technologies:
TransforMED MHVSA
S - Information
Systems, Q10
ISPCD
Office systems
and information
technology Q16-17
TransforMED BPS
S -New Model
Characteristics,
Q84
QUALICOPC
SComputerised
medical record
keeping, Q42
PCPSS
NSPOII
Q14ab
SB, Q29
Does your practice include at least 4 of the following technology components:
• Electronic Health Record System / • e-Prescriptions / • e-Appointment
scheduling / • Disease/population management software (either part of the EHR
or separate system) / •Evidence-based decision support / • Web-based
information sharing with patients (patient portal) / • e-Visits
Do you use any of the following technologies in your practice?
• Electronic ordering of laboratory tests / • Electronic access to your patients’
laboratory test results / • Electronic alerts or prompts about a potential problem
with drug dose or drug interaction / • Electronic entry of clinical notes, including
medical history and follow up notes / • Electronic prescribing of medication
IF YES TO Q16e. : Are you able to electronically transfer prescriptions to a
pharmacy?
o Patient scheduling / o Patient communication / o
Financial data management / o Website marketing / o
Patient clinical management / o General clinical
information retrieval from web sources (e.g. Evidence
based guidelines) / o E-mail
o Medication interaction checking / o Allergy checking /
o Dosing alerts by age, weight, or kidney function / o
Formulary information
o Yes / o No
o Yes / o No
Does your practice currently have adequate computer support?
o Yes / o No
For which of the following purposes do you use a computer in your practice?
o Not applicable (I don’t use a computer) / o Making
appointments / o Writing bills / o Writing medicine
prescriptions/ Keeping records of consultations / o
Sending referral letters to medical specialists / o
Searching medical information on the internet / o
Sending prescriptions to the pharmacy
a. During a typical day in clinic, how often do clinicians use a computer to look up
information about the patients they are seeing?
Patient medication lists / • Patient problem lists / • Laboratory results / • Abnormal
laboratory result alerts / • Radiology report / • Radiology image / • Office visits
notes from clinicians at the practice site / • Consultation notes from outside
specialists / • Hospital discharge summaries / • Emergency department discharge
summaries / • Electronic medication prescribing / • Medication interaction or
contraindication alerts / • Patient-specific formulary information while writing
prescriptions / • Prescriptions sent electronically / • Electronic laboratory test
ordering / • Electronic radiology test ordering / • Alerts of ordered tests are not
performed / • Electronic referrals to specialists / • Alerts if no note from specialist
referral / • Secure electronic messaging to and from patients
b. If they do, on the computer, are the following elements present?
Do the majority of your physicians have the ability to transmit prescriptions via
computer or personal digital assistant (PDA) to pharmacies?
o Never / o Rarely / o Sometimes / o Usually / o Always
o Yes / o No / Don’t know
o Yes / o No
61
Section/
question #
Questions ou items
NSPOII
SB, Q1-14
Does your IPA make available an electronic medical record that includes any of
these components…
1. Ambulatory care progress notes?
2. Are the majority of your physicians using the electronic record for progress
notes?
3. The patient’s problem list?
4. Are the majority of your physicians using the electronic record for the
patient’s problem list?
5. The patient’s allergies?
patient’s allergies?
7. The patient’s medications?
patient’s medications?
9. Automatic alerts of potential drug interactions?
10. Are the majority of your physicians using the electronic record for potential
drug interactions?
11. Decision support in the form of prompts or reminders at the time the
physician is seeing the patient?
12. Are the majority of your physicians using the electronic record for prompts
and reminders?
13. Alerts about important abnormal test results at the time they are received?
14. Are the majority of your physicians using for alerts on abnormal test results?
CPCQ
S - Practice
Profile, Q8
Please indicate if you use a computerized system at this practice site for any of
the following. (Please check all that apply.)
SB, Q17-28
Do the majority of physicians in your IPA have electronic access…
17. To clinical information on the patient's emergency room visits?
18. And, is this accessible within an individual patient’s electronic record?
19. How about electronic access to hospital discharge summaries?
21. How about electronic access to laboratory results?
23. How about electronic access to radiology results?
25. How about electronic access to outpatient reports from specialist
physicians?
27. Finally, how about electronic access to a record of prescriptions filled by
your patients?
Questionnaire
NSPOII
62
o Yes / o No
o Scheduling appointments / o Billing / o Patient Followup or recall / o Medical Record / o Referral and counterreferral with specialists / o Other (please specify)
____________
o Yes / o No
Questionnaire
NPS2010
COMP-PC
IMEPHC
IMEPHC
Section/
question #
Questions ou items
SI, Q28c
Please indicate which of the following you use, or plan to use, in the care of your
patients. (Check ALL that apply.)
• Electronic patient appointment/ scheduling system / • Electronic billing / •
Electronic records to enter and retrieve clinical patient notes / • Electronic
reminders for recommended patient care / • Electronic warning for adverse
prescribing and/or drug interactions / • Electronic interface to external
pharmacy/pharmacist / • Electronic interface to external laboratory/diagnostic
imaging / • Electronic interface to other external systems (e.g., hospitals, other
clinics) for accessing or sharing patient information / • Telemedicine /webcasting
/videoconferencing / • Online access to journals, clinical practice guidelines,
medical databases (e.g., MEDLINE) / • Email / • Online CME / • Online discussion
forums with other physicians for professional purposes
/ • Online disease management tools
o Use it on a PC/laptop / o Use it on a small handheld
wireless device / o Plan to start using on a PC/laptop or
wireless device in next 2 years / o I do not use or plan to
use any of the above
S1, Q6
S6, Q1
S6, Q2
Has your practice site implemented, to any extent, any of the following
information technologies: (Please check one in each item.)
• Access to the Internet
• E-Mail
• Electronic patient health records
• Electronic patient appointment/ scheduling system
• Electronic billing
• Electronic reminder systems for recommended patient care (e.g. screening)
• Electronic interface to external pharmacies/pharmacists
• Electronic interface to external laboratory/diagnostic imaging
• Electronic warning system for adverse prescribing and/or drug interactions
• Electronic decision aids
• Telemedicine/webcasting/ videoconferencing (IMEPHC only)
• A practice website
• Online access to journals, clinical practice guidelines or medical databases
• Remote access to patient records (from off-site).
• Other (Please specify_____________
Please indicate which type of information systems/software you have within your
organization, how well it meets your needs, how much it is used within your
organization, and the name(s) of the software you use.
Types of Information Systems/Software:
• Accounting related systems/software
• Claims/Billing Information Systems/Software
o Yes / o No / o Not Sure/ Don’t Know
Have Software?
o Yes / o No / o Don’t know
63
Questionnaire
Section/
question #
Evolution
SA, Q10
PCOS-NS
S7, Q20
Questions ou items
• Human Resources Systems/Software (e.g., Peoplesoft)
• Word Processing Software (e.g., Word)
• Spread Sheet Software (e.g., Excel)
• Provider, Location and Client Registry System/Software
• Patient Management Information Systems/Software (e.g. reminder system)
• Patient Scheduling Information Systems/Software
• Diagnostic Imaging Systems/Software
• Laboratory Reporting Systems/Software
• Drug Information Systems/Software
• Public Health Surveillance System/Software (e.g., Internet Public Health
Information Systems [IPHIS])
• Clinical Audit Systems/Software (e.g., practitioner outcomes compared to
benchmarks)
• Data Base Development and Management Software (e.g., Access)
• Presentation Software (e.g. Powerpoint)
• File Management Software (e.g. Lotus Notes)
• Electronic Patient Record Systems/Software
• Electronic Decision Aids Systems/Software (e.g. AsthmaCritic)
• Statistical Analytical Software (e.g. SPSS)
• Other, Specify:
In your clinic, do you use…
• Computer software to manage appointments?
• Internet access (web) for physician?
• Access to the health and social services telecommunications network (RTSS)?
• Electronic medical records?
• Web-based appointment system for patients?
• Electronic interface to diagnostic imaging laboratory services?
• Electronic system to transmit prescriptions to pharmacies?
• Computerized tools to aid medical decision-making (Computerized alerts and
recalls)?
• Computerized tools for continuing professional education?
• Practice clinical guidelines integrated with electronic medical records?
• Other (Specify: _____________________
• Does your primary health care organization use an electronic patient records?
• If yes, do you ever examine the data to assess quality of care issues (e.g.
influenzaimmunization rates in the elderly, etc.)?
How well it meets needs
o Very well / o Well / o Poorly / o Very poorly
How much it is used
o Very much / o Much / o Little / o Very little
o Yes / o No
o Yes / o No
• If yes, please briefly describe a few examples of issues you have examined.
PCOS-NS
S7, Q21
• Does your primary health care organization use an electronic prescribing/ drug
ordering system?
• If yes, does the system perform patient-specific medication alerts? (Please circle
one answer.)
TransforMED BPS
S -New Model
Characteristics,
Q88
Please describe the billing process of your office:
64
o Yes / o No
o We use software to do our own billing / o We do our
own manual billing / o We contract out for billing / o If
you use software to do your own billing, which one?
Questionnaire
Section/
question #
Questions ou items
TransforMED PEC
S - Online
Platform, Q8183
81. The use of electronic medical records during patient visits interferes with the
doctor-patient relationship.
82. The practice can easily identify patients with a particular disease or
medication.
83. Everyone in this practice has access to the information they need for patient
care and their work when they need it.
Please indicate how strongly you agree or disagree with
each statement.
o Strongly disagree / o Disagree / o Neutral / o Agree / o
Strongly Agree
Does your practice use a registry to facilitate:
o Population health management / o Individual health
management / o Proactive care / o Planned care visits
Do you have the access you need to these clinical decision support tools?
o Point-of-care answers to clinical questions / o
Medication information / o Clinical practice guidelines
Do you have these evidence-based medicine supports in place:
o Templates to guide evidenced-based treatment
recommendations
o Condition-specific templates to collect clinical data
o Alerts when parameters are out of goal range
o Home monitoring
TransforMED PCMHC
TransforMED PCMHC
TransforMED PCMHC
S - Health
Information
Technology,
Q11
S - Health
Information
Technology,
Q12
S - Health
Information
Technology,
Q10
Does your Independent Practice Association (IPA) access these electronic
records to collect data for quality measures?
Ressources organisationnelles / Ressources techniques / Communications électroniques avec les patients
S -New Model
TransforMED Web-based scheduling in which patients make an appointment without talking to
Characteristics,
BPS
the receptionist:
Q71
S -New Model
Electronic visits (use of e-mail or internet to communicate with patients.):
BPS
Q75
S -New Model
Web-based information sharing with patients:
BPS
Q78
Can a majority of your patients access any part of their electronic medical record
NSPOII
SB, Q16
online?
Would you say the majority of your physicians communicate with patients via eNSPOII
SB, Q30
mail....
Do you have a practice Web site?
NPS2010
SI, Q26a
If yes, can patients contact your office to request an appointment through your
website?
NSPOII
NPS2010
SB, Q15
SI, Q26b
o Yes / o No
used
used
used
o Yes / o No
o On a daily basis / o Occasionally / o Never
o Yes / o No
Do you refer your patients to any websites?
o Yes / o No
If yes, please specify for what purpose. (Check all that apply.)
o Disease information / o Treatment information / o
Patient support / o Other, please specify:
65
Questionnaire
Section/
question #
Questions ou items
NPS2010
SI, Q26c
Do you use email IN ANY SETTING to communicate with:
o Your colleagues: o For clinical purposes / o For other
purposes
o Your patients: o For clinical purposes / o For other
purposes
o Others
o Not applicable - I do not use email
ISPCD
Office systems
and information
technology Q18
How often does your practice communicate with patients by email for clinical or
administrative purposes?
o Yes / o No
Ressources organisationnelles / Ressources techniques / Communication électronique avec d’autres organisations
Do you have two-way electronic links (or share an electronic record) with the
following components of the health care system and, if so, in your view how well
Types of Organizations
do these links function?
• Hospitals / • Hospital Emergency Departments / •
PCOS-NS
S7, Q22
• Do you have electronic links?
Primary Care Physicians in solo practice / • Other
o Yes / o No / o Don’t Know
primary health care organizations / • Physician
• If yes: How well do the electronic links function?
specialists / • Tele-Triage / • Public Health / •
o Very Well / o Well / o Poorly / o Very poorly
Laboratory/Diagnostic / • Imaging Services / •
For each type of organization listed in the far right column, please indicate the
Ambulance Services / • Pharmacies / • Home Care / •
methods that your primary health care organization uses for communication with
Long Term Care Facilities / • Community Mental Health
these components of the health system.
/ • Health Insurance Companies (e.g., Blue Cross) / •
PCOS-NS
S7, Q23
• Telephone / • Teleconference / • Video conferencing / • Email (computer to
Other, Specify:
computer messaging) / • Fax / • Regular mail / • Internet chat sites / • Web-casting
/ • Interactive Websites / • Other, Specify
66
4.
STRUCTURES ORGANISATIONNELLES
4.1
GOUVERNANCE ET STRUCTURE ADMINISTRATIVE
Tous les enjeux liés à la gestion sont regroupés ici. La propriété, la structure organisationnelle verticale et horizontale, les processus
de prise de décisions, les politiques administratives et les éléments concernant la structure opérationnelle de la clinique (par
exemple le système de prise de rendez-vous) se retrouvent donc dans cette catégorie. Les aspects relatifs au leadership, à
l’intégration dans la communauté, et plus particulièrement l’implication du patient et des membres de la communauté dans la
planification stratégique des soins de santé, de même que les autorités organisationnelles, régionales et locales en matière de santé
figurent également dans la catégorie de la gouvernance.
Section/
Questions ou items
question #
Structures organisationnelles / Gouvernance et structure administrative / Propriété
NAMCS - PIIF
S2 - Q18e
Are you a full- or part-owner, employee, or an independent contractor?
Questionnaire
NAMCS - PIIF
S2 - Q18f
Who owns the practice?
TransforMED BPS
S - Practice
Information,
Q49
Who is the majority owner of your practice?
TransforMED FS
Q26
Which of the following describes the current ownership of your practice?
NSPOII - IPA
SA,Q1a
Do you own or manage a medical group?
NSPOII
SA, Q12
Who is the primary owner of your IPA? (Please choose ONE of the following.)
Structures organisationnelles / Gouvernance et structure administrative / Type de clinique
Do you have a solo practice, or are you associated with other physicians in a
NAMCS - PIIF
S2 - Q18a
partnership, in a group practice, or in some other way?
NAMCS - PIIF
S2 - Q18b
How many physicians are associated with you?
NAMCS - PIIF
S2 - Q18c
Is this a single- or multi-specialty practice?
S - Practice
TransforMED Demographics,
Is your practice a Federally Qualified Community Health Center?
BPS
Q5
o Owner / o Employee / o Contractor
o Physician or physician group / o Health Maintenance
Organization / o Community Health Center / o Medical /
Academic health center / o Other hospital / o Other health
care corp / o Other
o Physician owned / o Medical group practice (single- or
multi-specialty) / o Hospital or health system / o University /
o Managed care organization or Insurance company / o
Federal, state or local government, community board, etc. /
o Other non profit / o Other (please specify) _____
o Physician owned; sole proprietor / o Physician owned;
medical group / o Hospital owned / o Other (If “Other”,
please describe)____________
o Yes / o No
o Physicians in your IPA / o Non-physician managers in
your IPA / o Hospital, hospital system or health care system
/ o HMO or other insurance entity / o Jointly owned
(Specify) ______
o Solo / o Nonsolo
o Multi / o Single
o Yes / o No
67
Questionnaire
NAMCS CHCII
Section/
question #
Q8
NSPOII
S - Practice
Information,
Q47
SA,Q1
NPS2010
SB, Q10b
COMP-PC
S1, Q2
TransforMED BPS
PCOS-NS
S1, Q7
IMEPHC
S1,Q3
a
b
c
d
68
Questions ou items
How would you classify this center?
(Mark (x) ALL that apply.)
o Federally-funded Community Health Center / o
Community Health Center / o Migrant Health Center / o
Health Care for the Homeless / o Public Housing Primary
Care (PHPC grant program / o Federally Qualified Health
Center, but not federally funded / o Urban Indian Health
Center
o None of the above
What is the legal structure of the practice?
o S Corporation / o C Corporation / o Partner Owned / o
Sole Proprietor / o Other (please specify)_____
Are you an Independent Practice Association, that is, an IPA?
Are you incorporated:
- individually?
- as a group?
Please verify that this practice is a…
Recent work in Canada has identified four main categories of primary health
care organization models. These models are described below. Please place a
check mark by the model that best describes your primary health care
organization. If your organizational model is a mix of two or more of the models
listed below, please describe your model in the bottom row of the table.
Please identify the governance structure of this practice:
o Yes / o No
o Yes / o No
o Fee-For-Service (FFS) / o Health Service Organization
(HSO) / o Family Health Network (FHN)
Model That Best Reflects Our Organization:
o Professional Contract Modela
o Professional Coordination Modelb
o Integrated Community Modelc
o Non-Integrated Community Modeld
o Mixed Model or Other / Please describe what mix of the
four models described above best reflects your
organization or another model that better reflects your
organization:___________________________
o Community governed / o Physician governed / o Other
_________
This is a model in which care is provided primarily in a physician’s office by a family physician in solo or group practice. It is staffed primarily by physicians and generally
reimbursement is on a fee-for-service basis. Information systems are for internal use. There are no formal mechanisms to ensure the continuity of care except loyalty to the
physician and there are no formal mechanisms to ensure integration with other parts of the health care system, other than physician affiliations with other resources of care (e.g.,
referrals to specialists).
Organizations provide continuous service over time to a defined group of patients/population. Funding is based on a per capita, sessional fee, fee-forservice or other model(s), or a
mix of models. There are non-physicians such as nurses on the care team and a physician or nurse is designated to provide followup and continuity of care for the patient. There
will generally be a nurse who provides liaison with other parts of the health care system and coordinates the clinical integration of services.
The focus of this model is to promote the integration of primary health care into the other parts of the health care system. There is generally a range of providers operating in a
community health centre format. Information technology serves the organization and is linked to other, external service providers serving the population. Care responsibility is
longitudinal (long term) and is provided by a multi-disciplinary care team. There is active cooperation and coordination with other primary health care providers and with providers of
complementary services such as hospitals to guarantee the availability of a range of services.
This model is similar to the integrated model in its structure but is differentiated by a lack of specific integration mechanisms. For example, information systems do not link to other
parts of the health care system. Services are not provided on a 24/7 basis and there are generally no, or few, mechanisms to ensure the longitudinal continuity of care services to
individuals.
Questionnaire
Section/
question #
Questions ou items
TransforMED BPS
S - Practice
Demographics,
Q3
Please choose one of the following below that best describes your practice size
(Clinician refers to physicians, nurse practitioners, physician assistants, or other
revenue generating physicians)
NPS2010
SB, Q10a
Please indicate how your MAIN patient care setting is organized. (Please check
only one.)
Note that a solo or group practice could also include a nurse who does not have
her/his own caseload.
NPS2010
SB, Q4a
The following is a list of work settings. Check the category(ies) which best
describe(s) the setting(s) where you work. (Please check ALL that apply.)
IMEPHC
S4, Q1
CPCQ
S - Practice
Profile, Q2
Please check the category(ies) which best describe(s) this practice setting(s).
(Please check ONE only.)
ISPCD
Practice Profile
and
Demographic
Data - Q40
What is the primary setting of your practice site? (Select one.)
o Solo / o 2-clinician practice / o Medium Family Medicine
Group (3-5 clinicians same specialty practice) / o Large
Family Medicine Group (6 or more same specialty
clinicians) / o Multi-specialty Group / o Faculty/resident
practice / o Other (please specify) __________
o Solo practice
o Group practice - association (i.e., fee/cost-sharing
relationship)
o Group practice - partnership (i.e., fee/cost-sharing;
income sharing and financial/medical liability sharing)
o Interprofessional practice (physician(s) and other health
professional(s) who have their own caseloads)
o Private office/clinic (excluding free standing walk-in
clinics) / o Community clinic/Community health centre / o
Free-standing walk-in clinic / o Academic health sciences
centre (AHSC) / o Non-AHSC teaching hospital / o
Community hospital / o Other hospital / o Emergency
department (in community hospital or AHSC) / o Nursing
home/Home for the aged / o University / o Research Unit /
o Free-standing lab/diagnostic clinic / o Administrative
office / Corporate office / o Other:
o Private office / clinic (excluding free standing walk-in
clinics)
o Free-standing walk-in clinic
o Academic family medicine teaching unit
o Community clinic / Community health centre / Centre
local de services communautaires
o Other (please specify): ______________
For physicians in the United States:
o A private solo or physician group practice
o Community clinic or community health center
(serving low income areas)
o Ambulatory center or clinic affiliated with hospital
o On site at hospital, medical-center
o Walk-in care center – sometimes called retail clinic
o Other __________________________________
For physicians in Canada:
o A fee-for-service solo practice
o A fee-for-service group practice
o A family medicine group that receives complementary
public funding
o A local community health centre
o A hospital other than emergency department or FMG colocated with a university hospital
o Emergency department
69
Questionnaire
Section/
question #
Questions ou items
o A walk-in clinic
o Other __________________________________
o Solo practice / o Family physician group practice / o
Family physician / specialist group practice
CPCQ
S - Practice
Profile, Q3
Please indicate how this practice setting is organized. (Please check ONE only.)
Do physicians in your practice site share any of the following with other
physicians in your practice site? (Please check one in each of the following
items.)
COMP-PC
S1, Q10
• Office space / • Patient records / • On-call duties / • Receptionist(s) / • Nurse(s)
/ • Information technology tools / • OHIP billing submissions / • Other (please
specify) ____
Do any general practitioners at your clinic share…
• Rooms (offices, examination rooms, waiting room)? / • Operating costs for the
Evolution
SA, Q5
clinic? / • Support staff (secretary and receptionist)? / • An appointment
management system? / • Medical record system? / • Pooled income?
Structures organisationnelles / Gouvernance et structure administrative / Planification financière
S - Patient
TransforMED Is there a specific managed care plan that controls over 50% of your practice's
Demographics,
BPS
total business?
Q17
For group practice please indicate what is shared. Please
check all that apply.
o Office space / o Staff / o Expenses / o Patient records / o
On-call duties / o Office hours / o Intrapartum care / o
Rounds for hospitalized regular patients / o Other (please
specify): ______________
o Yes / o No / o Doesn’t apply because only 1 doctor in the
clinic
o Yes / o No
TransforMED PCMHC
S - Practice
Organization,
Q14
Rigorous financial management is essential. Are you:
o Budgeting for forecasting and management decisions / o
Contracting with health plans from a selective and informed
position / o Managing the practice’s cash flow / o Staying
on top of accounts receivable
TransforMED MHVSA
S - Practice
Management,
Q8
Does your practice receive and review monthly reports on the financial status of
the practice?
o Yes / o No
Which of the following financial statements and reports are available and
reviewed by management at the practice level on a monthly basis?
a. Income Statement.
b. Balance Sheet.
c. Cash Flow Statement.
d. Patient volume by clinician.
e. Net revenue per patient, per clinician.
f. Accounts Receivable Aging Report.
g. Other clinician productivity reports.
If choice “g” was selected, please describe.
_____________________
TransforMED FS
70
Q10
Section/
Questions ou items
question #
Structures organisationnelles / Gouvernance et structure administrative / Planification stratégique
Does the practice # local GP organisation undertake any of the following?
NATMEDCA S - Access,
a) Formal community needs assessment
Practice Q.
Q6a,b
b. Locality service planning
Questionnaire
o Yes / o No
o No / o Yes – A physician-in-charge or designates
physician / o Yes – The group physicians collectively / o
Yes – Administrator/manager / o Doesn’t apply because
only 1 doctor in the clinic
Evolution
SA, Q4.f
At your clinic, is there anyone who represents the clinic on committees? (Circle
only one answer.)
PCOS-NS
S2,Q10
• Does your primary health care organization involve community members in
planning the services provided by the organization?
If Yes: In what ways are community members involved?
o Yes / o No
TransforMED BPS
S - Practice
Information,
Q59
How often does this practice hold meetings to discuss business issues?
o More than once a week / o Weekly / o Monthly / o
Quarterly / o Annually / o Never / o Other (please specify)
Please select all planning tools that are used in your practice.
o Strategic Plan with mission and vision statements.
o Annual Business Plan with monthly budget.
o Formal cost/benefit analysis for any major additions
including staffing, equipment and ancillary services.
o Other - Please specify “Other”.
_______________________
TransforMED FS
TransforMED BPS
TransforMED PCMHC
TransforMED MHVSA
Q13
S - Practice
Characteristics,
Q40
S - Practice
Organization,
Q16
S - Practice
Management,
Q9
COMP-PC
S2,Q6
PCOS-NS
S2,Q8
Please describe any practice management software utilized by your practice
Does the practice rely on data to drive decisions to:
o Continuously improve quality and efficiency
o Monitor supply and demand
o Ensure adequate and fair distribution of work
Has a strategic vision and direction been developed and reviewed by the
practice leadership and shared with the staff?
o Yes / o No
Does your practice site use the following types of data to determine what
programs/services are needed by the communities you serve? (Please check
one in each item.)
• Mortality data / • Public health communicable disease data (e.g., STDs, TB) / •
Community immunization rates / • Public health data on health or occupational
hazards / • Clinical data from your practice / • Other (please specify)_________
Does your primary health care organization use information about the population
you serve to guide decisions about the type of programs and services to offer?
If Yes:
(i) What kind of information do you use?
(ii) What is the source of this information?
(iii) Please provide examples of programs or services that were offered based on
the above information.
o Definitely (Always) / o Probably (Usually) / o Probably not
(Rarely) / o Definitely not (Never) / o Not sure, Don’t Know
“
o Yes / o No
71
Questionnaire
COMP-PC
Section/
question #
Questions ou items
S2,Q7
Does your practice site use the following methods to monitor and/or evaluate the
effectiveness of services/programs if offers? (Please check one in each item.)
• Surveys of the practice patients / • Community surveys / • Feedback from
community organizations or community advisory boards / • Feedback from the
practice staff / • Analysis of local data or vital statistics / • Systematic evaluations
of the practice programs and services provided / • Community health workers / •
Have a patient on the Board of directors or advisory committee / • Other (please
specify) ____________
o Definitely (Always) / o Probably (Usually) / o Probably not
(Rarely) / o Definitely not (Never) / o Not sure, Don’t Know
o A designated physician manages the clinic.
o Regular meetings with all the physicians to make
decisions about service delivery (e.g., opening hours,
purchase of supplies)
o Regular meetings with all the physicians to make
decisions about how care is organized (e.g. recall systems
for patients, use of flow sheets)
o Continuing medical education for the group.
o Evaluation and medical audit activities for and by the
group.
o Designated physician to communicate with support
personnel.
o Designated physician to make links with the community
and other regional medical organizations.
o No / o Yes – A physician-in-charge or designates
CPCQ
S - Practice
Profile, Q7
Please indicate how the management of the clinic is organized. (Please check all
that apply.)
Evolution
SA, Q4.c
At your clinic, is there anyone who looks after recruitment of physicians and
assigns practice privileges? (Circle only one answer.)
TransforMED BPS
S - Practice
Information,
Q61
Does the practice have regular meetings for… (Choose all that apply.)
o Clinicians / o Staff / o Clinicians and staff together / o
Other affiliated practices
S4, Q6
Chart Organization- Please indicate with a check mark whether these are
present:
• Is there a medication list in the patient’s records?
• Is the chart organized by provider?
• Is the chart organized by thematic area? (e.g. asthma, mental health.)
*Note only the presence of this list and not, whether it is updated regularly or not.
The list may take the form of a central list or as part of an annual assessment.
This may be a stand alone sheet or it may be part of the annual assessment
where the provider lists all medication
o Yes / o No
“
IMEPHC
72
Section/
Questions ou items
question #
Structures organisationnelles / Gouvernance et structure administrative / Politiques et procédures administratives
TransforMED Does your practice have internal control policies and procedures in place to
Q14
o Yes / o No
FS
detect the possibility of embezzlement?
Please indicate whether your organization has a WRITTEN policy and/or policy
related materials, on the following topics.
• Human resources management / • Staff training / • Job descriptions / •
Performance appraisals / • Feedback on staff performance / • Staff development
o Yes, written / o No
IMEPHC
S5, Q1
/ • Recognition of merit/excellence / • Service delivery / • Medical errors / •
"
Referral/liaison/follow-up care with other health care services (e.g. hospital,
pharmacy, home care) / • Knowledge development / • Continuous quality
improvement / • Conduct of patient/client satisfaction surveys
Policy refers to some form of administrative statement, direction or rule.
Procedures refer to how these statements, directions or rules are to be carried
out. Please indicate if your primary health care organization has policies and/or
(i) o Yes, written / o Yes, unwritten /o No
procedures on any of the following issues:
• Risk management / • Patient safety / • Medication errors / • Recording of
(ii) o Very clear / o Clear / o Unclear
PCOS-NS
S6, Q19
current medication and problem list in all patients’ files.
(i) Does your organization have a policy and/or procedures on this topic area?
(iii) o Very high adherence / o Moderate adherence / o Low
(ii) If you have a policy and/or procedures, how clearly articulated are they?
adherence
(iii) If you have a policy and/or procedures, to what degree do members of your
”
organization adhere to the policy or procedures?
34. The leadership in this practice is available for consultation on problems.
35. The practice leadership makes sure that people in this practice have time
each statement.
and space necessary to discuss changes to improve care.
TransforMED S - Leadership
36. Practice leadership promotes an environment that is an enjoyable place to
PEC
Q34-37
Strongly Agree
work.
37. Leadership in this practice creates an environment where things can be
“
accomplished.
o Job descriptions for all clinical and administrative people
associated with the primary care organization / o
What accountability mechanisms are used by your primary health care
Collaborative practice agreement / o Practice plan / o
PCOS-NS
S3,Q12
organization? (Please check all that apply).
Shared care arrangement / o Terms of reference / o Other please specify:
Structures organisationnelles / Gouvernance et structure administrative / Développement professionnel
S - Practice
TransforMED Is your practice a Residency Training Practice?
o Yes / o No
Demographics,
BPS
If no, do you regularly have residents in your practice for training? _________
Q6
S - Practice
Do you precept medical students in the practice?
o Yes / o No
BPS
Q7
Is your major practice site a teaching practice?
o For undergraduates / o For junior doctors / o For GP
BEACH - GP
Q20
registrars / o No
In a typical week, do medical residents or clinical fellows provide care to patients
PPQCS
Q23
o Yes / o No
at your practice site?
PPQCS
Q24
In a typical month, do medical students rotate through your practice site?
o Yes / o No
Questionnaire
73
Questionnaire
IDCP2D - TIS
74
Section/
question #
S - Practice
Demographics,
Q3
Questions ou items
Is it a Training practice?
o Yes / o No
4.2
MÉCANISMES DE FINANCEMENT
Dans cette catégorie se retrouve la description des méthodes utilisées pour répartir les ressources entre les intervenants, de façon à
répondre aux exigences et aux objectifs gouvernementaux. On y retrouve également l’information relative à la rémunération
(salaires, honoraires, capitation, contrats, etc.), aux mesures incitatives, aux subventions et aux autres modalités.
Section/
Questions ou items
question #
Structures organisationnelles / Mécanismes de financement / Source de revenus
Roughly, what percent of your patient care revenue comes from –
NAMCS - PIIF
• Medicare? / • Medicaid? / • Private insurance? / • Patient payment? / • Other? –
S2 - Q26a
(Including charity, research, CHAMPUS, VA, etc)
Roughly, what percent of your patient care revenue comes from each of the
following methods of payment?
• Usual, custumary and reasonable fee-for-service? / • Discounted fee for
NAMCS - PIIF
S2 - Q27
service? / • Capitation? / • Case rates (e.g., package pricing/episode of care)? / •
Other?
From those "new" patients, which of the following types of payment do you
accept?
NAMCS - PIIF
S2 - Q28b
• Private insurance – Capitated? or Non-capitated?
• Medicare? / • Medicaid? / • Workers compensation? / • Self-pay? / • No charge?
What percent of your CHC's revenue comes from the following sources?
NAMCS • 330 Grant / • Title V grant or contract / • Other Federal Grant / • State/Local
Q10
CHCII
Grant / • Individual, corporation or foundation grants or donations / •
Medicare/Medicaid / • Patient fees / • Other
Please indicate the percent of your patients that fall into each payment method
S - Patient
TransforMED category. (Must total 100%.)
Demographics,
BPS
• Private health insurance (capitated) / • Private health insurance (fee for service)
Q16
/ • Medicare / • Medicaid / other government assistance / • Uninsured / • Other
S - Practice
Does the practice charge a retainer fee for services to patients?
BPS
Q62
At your practice site, approximately what percentage of patient visits is covered
by each of the following payers?
PPQCS
Q29
• Commercial health plans / • Medicare / • MassHealth or Commonwealth Care / •
Uncompensated Care Pool (“Free Care”) / • Other / self pay
Practice Profile
About what percentage of your patients are in each of the following categories?
and
(Total can add to more than 100%.)
ISPCD
Demographic
Data - Q39
Approximately what percentage of patient visits at your practice site is covered by
PCPSS
Q29
each of the following payers?
• Commercial health plan / • Medicare / • Medicaid / • Other / Self pay
During the 2010 fiscal year, approximately what percentage of your practice site’s
PCPSS
Q30
revenues from patient care was obtained under capitation arrangements?
COMP-PC
S3, Q2
Please indicate whether the practice site received revenues from any of the
Questionnaire
Percent of patient care revenue________%
“
Percent of patient care revenue________%
“
o Yes / o No / o Don't know
"
Percentage:_____%
"
o Yes / o No
_______% or o Don’t know
___ % Medicare / • ___ % Medicaid or low income program
for children or adults / • ___ % Private or other insurance /
•___ % Uninsured
75
Questionnaire
Section/
question #
Questions ou items
following sources during the past 12 months.
a. Program funding from Provincial/ Federal Government Departments
b. City/Municipality/Local Government Agencies
c. United Way
d. Foundations and Corporate Gifts
e. Parking Revenue
f. Direct charges to patients
f1. Prescription renewal
f2. Block fees (annual fee for non-insured services)
f3. Sick forms (i.e. off-work)
g. Other, please specify_____________
Does the funding for your clinic’s operating costs come from…
• Fees charged to physicians or contributions by physicians? / • Private
enterprise (companies, pharmacies, donations, foundation, etc.)? / • Fees
Evolution
SA, Q9
charged to patient (e.g. fees to open or manage files)? / • An institutional
operating budget (CLSC, hospital)? / • Infrastructure operating grant (Family
Medicine Group (FMG), Network-Clinic)?
Please indicate whether the practice site received revenues from any of the
following sources during the past 12 months.
IMEPHC
S10, Q5
• Direct charges to patients / • Prescription renewal / • Block fees (annual fee for
non-insured services) / • Sick forms (i.e. off-work)
Structures organisationnelles / Mécanismes de financement / Type de rémunération
NATMEDCA What are your employment arrangements during regular day-time for your
Q10
PQ
standard office hours?
NATMEDCA PQ
Q12
What are your after-hours employment arrangements?
How are physicians paid at your site? (Please check one.)
If you check b. Check box in 1a if the formula involves the following method of
payment:
COMP-PC
S3, Q1
Evolution
SA, Q2
What is their main mode of remuneration for activities conducted at your clinic?
(Choose one answer only.)
TransforMED BPS
S - Practice
Information,
Q55
How are clinicians compensated in your practice?
76
“
o Yes / o No
“
o Yes / o No / o Not sure/Don’t know
"
o Self-employed
o Salaried
o Self-employed
o Salaried
o Not applicable
o a. Individual physicians keep their individual billings and
share expenses.
o b. Physicians pool their revenue and expenses and net
income is distributed according to a formula.
o 1a.Total Pooled Practice Site Income /Total Number of
Physicians
o 1b. If the formula in 1a is not applied at your site, please
use the space below to describe how net revenue is
distributed among physicians (e.g., does it involve
physician seniority, ownership of building, etc?)
o Fee for service / o Sessional fees (vacation) / o Fixed
honorarium / o Various modes of payment
o Salary / o Salary, plus incentives / o Production driven
salary / o Other _____
Questionnaire
Section/
question #
Questions ou items
Do physicians (at least some) in your practice receive the following benefits as
part of their employment contract? (Please check one in each item.)
• Maternal/Paternal leave top up / • (supplement to employment insurance) / •
On-call stipends / • Travel allowance for continuing education / • Pension or
IMEPHC
S10, Q4
equivalent retirement savings plan / • Life/Disability Insurance / • Extended
Health and Dental Benefits / • Professional Fees (CPSO or OMA or CMPA or
OCFP) / • Professional Development Provisions / • Professional insurance / •
Other Benefits (please specify) __
Structures organisationnelles / Mécanismes de financement / Mesures incitatives
What other aspects of care determined the payment of bonuses or withholds in
PCPSS
Q34
2010?
During the past year, did your Independent Practice Association (IPA) or the
NSPOII
SE, Q4
individual physicians in the IPA receive any additional income based on
measurement of performance on patient satisfaction?
During the past year, did your IPA or the individual physicians in the IPA receive
NSPOII
SE, Q5
any additional income from health plans based on measures of clinical quality
such as Healthcare Effectiveness Data and Information Set (HEDIS)?
NSPOII
SE, Q6
any additional income from health plans based on measurements of your
performance of adoption or use of information technology?
Approximately what percent of your IPA's annual revenue did these additional
NSPOII
SE, Q7
payments for patient satisfaction, clinical quality and information technology
constitute?
NSPOII
SE, Q8
How strong an incentive is this amount to influence behavior?
NSPOII
SE, Q10
additional income from health plans based on efficient utilization of resources?
What percent of your IPA’s annual revenue did these additional payments for
NSPOII
SE, Q11
efficient utilization of resources constitute?
Do you have the potential to receive or do you receive extra financial support or
incentives based on any of the following? (This includes bonuses, special
payments, higher fees, or reimbursements.)
Measuring
• High patient satisfaction ratings
Practice
• Achieving certain clinical care targets
ISPCD
Improvement • Managing patients with chronic disease or complex needs
Q25
• Enhanced preventive care activities, including patient counseling or group visits
• Adding non-physician clinicians to your practice team (e.g., nurse for chronic
disease management)
o Yes / o No / o Not sure/Don’t know
"
__________________________________ / or o None
o Yes / o No
o Yes / o No
o Yes / o No
____________%
o Very Strong / o Strong / o Weak / o Not at all
o Yes / o No
____________%
o Yes / o No
a)
TransforMED BPS
S - Practice
Staffing
Demographics,
Q39
Practice Rewards (Please distribute 100 points) 2
b)
c)
Practice Organization A distributes its rewards fairly
equally among its members. It’s important that
everyone from top to bottom be treated as equally as
possible._______%
Practice Organization B distributes its rewards based
on individual initiative. Those with innovative ideas
and actions are most rewarded._______%
Practice Organization C distributes its rewards based
77
Questionnaire
Section/
question #
Questions ou items
d)
78
on rank. The higher you are, the more you
get._______%
Practice Organization D distributes its rewards based
on achievement of objectives. Individuals who provide
leadership and contribute to attaining the practice’s
goals are rewarded. ____%
4.3
PROCÉDURES CLINIQUES
Les procédures cliniques se définissent comme les structures mises en place pour gérer les décisions cliniques. Les détails
concernant la répartition du travail entre les médecins, les mécanismes de prise de décisions cliniques, les modèles d’organisation
des services, de même que les stratégies de partage de l’information, de collaboration, de coordination et d’intégration (par
exemple : les discussions concernant les cas légaux, un guide de pratiques cliniques, etc.) se retrouvent dans cette catégorie.
Section/
Questions ou items
question #
Structures organisationnelles / Procédures cliniques / Mécanismes de prise de décisions cliniques
S - Practice
How often does this practice hold meetings to discuss clinical issues?
BPS
Q60
TransforMED S-Team-Based
Does your medical team and office staff meet at least weekly to discuss office
MHVSA
Care, Q1
operations and clinical practice functions?
S - Continuity of
TransforMED Does your practice routinely employ and document a mechanism for tracking
Care Services,
MHVSA
tests, referrals and follow-up on results?
Q3
Within your General Practice …
• Procedures are designed to collect accurate information necessary for making
decisions.
• Procedures are designed to provide opportunities to appeal or challenge the
decision
• Procedures are designed to have all sides affected by the decision
represented.
• Procedures are designed to generate standards so that decisions could be
IDCP2D
S1, Q4
made with consistency.
• Procedures are designed to hear the concerns of all those affected by the
decision.
• Procedures provide useful feedback regarding the decision and its
implementation.
• Procedures are designed to allow for requests for clarification or additional
information about the decision.
Does your practice monitor prescribing?
S - Structure,
IDCP2D - TIS
(How is this done? Do they have an internal process or is monitoring done by
Q20
PCT?)
Questionnaire
IDCP2D - TIS
S - Structure,
Q22
What types of meetings does your practice hold? (e.g. “partnership meetings”,
“practice management meetings”, “educational meetings”, “quality of care
meetings”)
Practice / Partner / Educational / Admin / Clinical / Other : ________
o More than once a week / o Weekly / o Monthly / o
Quarterly / o Annually / o Never / o Other (please specify)
o Yes / o No
o Yes / o No
Strongly Disagree
1
2
3
4
Strongly Agree
5
6
7
o Yes / o No
Type of meeting:_____________________
How often held:_____________________
Who attends (e.g. GPs, Nurses and/or admin staff)
:_____________________
How long they last:_____________________
“
79
Section/
question #
Questions ou items
IMEPHC
S8, Q1
Please indicate which policies, standards and protocols your team currently has
in place and which are currently being used.
• Case management standards
• Case management forms (paper or electronic) integrated into medical records
• Standardized forms (paper or electronic) for treatment/service plans
• Standardized referral forms (paper or electronic)
• Care pathways or standards for referral
• Standardized protocols for holding case conferences
• Protocols for recording minutes of case conferences
• Protocols in place to share information between all team members?
• Standardized forms (paper or electronic) for patient/client assessment
TransforMED MHVSA
S - Continuity of
Care Services,
Q3
Does your practice routinely employ and document a mechanism for tracking
tests, referrals and follow-up on results?
Questionnaire
a. At your clinic, is there anyone who sets up on-call lists, schedules, vacation,
etc.?
Evolution
SA, Q4.a,b
b. At your clinic, is there anyone who organizes meeting for case discussions?
(Circle only one answer.)
Structures organisationnelles / Procédures cliniques / Soutien aux patients
In place?
o Yes / o No / o NA
Being Used?
o Yes / o Partially / o No / o NA
"
o Yes / o No
o No / o Yes – A physician - in-charge or designated
o Reminder systems that prompt you to provide important
clinical interventions for your patients
o Reminder systems and/or educational materials that
prompt your patients to obtain recommended care
o No / o Yes – A physician - in-charge or designated
NFPWS2001
S - Education/
Training, Q47
Do you use:
(Please check all that apply.)
Evolution
SA, Q4.g
At your clinic, is there anyone who develops collective prescriptions/ protocols
for care? (Circle only one answer.)
Evolution
SB, Q14
At your clinic, do you have…
• A reminder system to invite patients to have the recommended screening tests
(e.g. Pap test)?
• A checklist in the file concerning the preventive clinical practices (counseling,
screening, immunization) to carry out with patients, according to the guidelines
that are in effect?
• A tool to assist lifestyle habit counseling (e.g. for smoking cessation
interventions)?
• A reference tool for services offering support for lifestyle changes (e.g.
smoking cessation centre, health education centre)?
• A chart, in the files of patients with chronic diseases, that includes all the
important follow-up components listed in patient management guidelines (e.g.
glycated HB in diabetic patients)?
o No / o Yes, computerized / o Yes, paper
"
ISPCD
Access to Care
and Caring for
Patients - Q8
Do you provide patients with a list of the medications they currently take?
80
Questionnaire
Section/
question #
Questions ou items
Are the following tasks routinely performed in your office practice?
• Patients are sent reminder notices when it is time for regular preventive or
follow-up care (e.g., flu vaccine or HbA1C for diabetic patients)
ISPCD
• All laboratory tests ordered are tracked until results reach clinicians
• You receive an alert or prompt to provide patients with test results
• You receive a reminder for guideline-based intervention and/or screening tests
Structures organisationnelles / Procédures cliniques / Tenue des dossiers médicaux
Office systems
and information
technology –
Q20
QUALICOPC
S - Medical
record keeping,
Q38
How do you keep patient medical records?
QUALICOPC
S - Medical
record keeping,
Q40
Does your medical record system normally include the following information:
(Tick all that apply.)
IMEPHC
S8, Q2
Which of the following health/ psychosocial needs are consistently addressed in
all patient records?
NPS2010
SI, Q27
Thinking about your MAIN patient care setting, which of these describes your
record keeping system?
(Please check only one.)
Office systems
and information
technology Q19
With the patient medical records system you currently have, how easy would it
be for you (or staff in your practice) to generate the following information about
your patients? Is this process computerized?
• List of patients by diagnosis (e.g., diabetes or hypertension)
• List of patients by lab result (e.g., HbA1C>9.0)
• List of patients who are due or overdue for tests or preventive care (e.g., flu
vaccine due)
• List of all medications taken by an individual patient (including those that may
be prescribed by other doctors)
ISPCD
QUALICOPC
S - Medical
record keeping,
Q41
In the past 2 years, have you used your medical record system to list a selection
of patients?
o Yes, using a computerized system / o Yes, using a
manual system / o No
o I keep records except for minor or trivial complaints / o I
keep records of all frequently attending patients / o I keep
records, unless it is too busy / o I keep records routinely of
all patient contacts / o Don’t know
o Not applicable (I don’t use a computer for my medical
records) / o Living situation / o Ethnicity / o Patients’ family
history (depression, cancer) / o Patients’ weight and height /
o Smoking / o Blood pressure / o Reason for encounter / o
Diagnosis / o Prescribed medications / o Test results
o Medications / o Support Groups / o Education Patient
Received / o Vocational training/education / o Adherence
Issues (e.g., medication compliance) / o Family Situation / o
Financial Need / o Living Arrangements / o Assistance
Eligibility / o Legal Issues / o Housing / o Home Care / o
Food/Nutrition (Food Security) / o Foster Care / o Child
Care / o Adoption/ Permanency Planning / o Mental Health /
o Substance Abuse / o Other: Specify:
____________________
o I use paper charts only / o I use a COMBINATION OF
PAPER AND ELECTRONIC charts to enter and retrieve
patient clinical notes / o I use electronic records INSTEAD
OF PAPER CHARTS to enter/retrieve patient clinical notes /
o Not applicable - I do not provide patient care
o Easy / o Somewhat Difficult / o Difficult / o Cannot
Generate
Is Process Computerized?
o Yes, Computerized / o No
o Not applicable (I don’t use a computer for my medical
records) / o By age group (e.g. those above age 50) / o By
diagnosis or health risk (e.g. diabetes or hypertension) / o
By medications they take (e.g., patients on multiple
medications) / o Who need a reminder for prevention or
follow-up
81
Section/
Questions ou items
question #
Structures organisationnelles / Procédures cliniques / Organisation des services
S - Patient
If new patients enter your practice, do you or your nurse normally have an
QUALICOPC
turnover, Q37
intake conversation?
At your clinic, …
a. Is there staff mainly assigned to reception of patients?
Evolution
SB, Q1a-b
b. Is there staff mainly assigned to manage medical records (opening new files,
managing archives)?
Do any general practitioners at your clinic share…
• Coverage of walk-in clinic periods? / • Coverage of scheduled appointments
Evolution
SA, Q6
periods? / • In-hospital care for clinic patients? / • Patient follow-up? / •
Replacement for physician absent from the clinic?
TransforMED S-Point of Care
Does your practice conduct pre-visit planning to create reminders for specific
MHVSA
Servce, Q4
tests, medication review, and preventive and follow-up care?
S - Practice
CPCQ
Does a nurse do triage of acute care (during walk-in hours)?
Profile, Q10
Questionnaire
Evolution
82
SB, Q26
In general, appointments with specialists are made by…
o Yes, always or usually / o Only occasionally / o Rarely or
never
o Yes / o No
o Yes / o No / o Doesn’t apply because only 1 doctor in the
clinic
“
o Yes / o No
o Yes / o No
o The patient / o Clerical staff / o The clinic nurse / o The
physician
4.4
MÉCANISMES D’AMÉLIORATION DE LA QUALITÉ ET DE LA SÉCURITÉ DU PATIENT
L’existence de procédures de contrôle et d’amélioration de la qualité, comme l’évaluation des résultats et de la satisfaction, la
formation professionnelle continue, les initiatives d’amélioration de la qualité, l’application de modèles d’amélioration (par exemple :
PDSA, LEAN, etc.), de même que les mécanismes mis en place pour assurer la sécurité du patient (procédures de collecte et de
suivi des plaintes, implantation de guide de pratique, conciliation des médicaments, mécanismes d’imputabilité, etc.), sont des
aspects important de la structure organisationnelle et sont documentés dans cette catégorie.
Section/
Questions ou items
question #
Structures organisationnelles / Mécanismes d’amélioration de la qualité et de la sécurité du patient /
Processus et Initiatives d’amélioration de qualité
S - Quality
NATMEDCA management,
Does the practice have a written training policy for staff?
Practice Q.
Q17
S - Quality
Does the practice have a written development policy for staff?
Practice Q.
Q18
S - Quality
NATMEDCA Does the practice have a written policy for ongoing quality management (
management,
Practice Q.
e.g. "GNZCGP quality programme, CHASP")?
Q19
S - Quality
Does the practice have a formal peer review process?
Practice Q.
Q20
S - Practice
25. How does your practice motivate clinicians (MD, DO, NP, PA)?
34. How does your practice motivate staff?
BPS
Demographics
(Fill all that apply.)
, Q25, 34
5. People in this practice actively seek new ways to improve how they do
things.
6. This practice is able to easily adjust routines to deal with unusual
STransforMED situations.
Mindfulness,
PEC
7 People in this practice are thoughtful about how they do their jobs.
Q5-8
8. People at all levels of this office openly talk about what is and isn’t
working.
Questionnaire
TransforMED PEC
S - Reflection,
Q31-32
TransforMED MHVSA
S-Quality and
Safety, Q5
PCPSS
Q1
31. People in this practice regularly take time to reflect on how they do
things.
32. After trying something new, people in this practice take time to think
about how it worked.
Does your practice participate in a performance reporting and improvement
process at least quarterly?
At your practice site is there one individual who initiates and leads most
quality improvement efforts?
o Yes / o No
o Yes / o No
o Yes / o No
o Yes / o No
o Compensation bonus / o Socializing opportunities / o Travel
opportunities / o Continuing education opportunities / o
Recognition / o Encourage development of new skills / o Career
advancement / o Other (please specify)
statement.
Strongly Agree
“
statement.
Strongly Agree
“
o Yes / o No
83
Questionnaire
PPQCS
Section/
question #
Q4a,b
PCPSS
Q2
PCPSS
Q3
PCPSS
Q4
PCPSS
Q5
PPQCS
Q3
NSPOII
SE, Q13-16
NSPOII
SE, Q17
NSPOII
84
SH, Q5-6
Questions ou items
a. At your practice site is there one individual who initiates and leads most
efforts to improve clinical quality?
(if there is more than one individual check “No”)
o No/Don’t know / o Yes
If YES, is this person a…
o Physician / o Non-physician clinician (e.g., RN, NP, PA) / o
Other member of the practice site staff
Approximately how often do the clinicians and staff at your practice site
hold meeting to discuss the practice site’s performance on…
• Clinical quality profiles? / • Patient satisfaction rating? / • Productivity? / •
Utilization or costs of care? / • Physician or staff experience?
Approximately how often do the clinicians and staff at your practice site
hold meeting to discuss the quality of care delivered by…
• Specialists outside the practice? / • Hospital serving patients of practice?
Does your practice site give feedback to individual clinicians or staff about
their personal performance on…
• Clinical quality profiles? (e.g. HEDIS measures) / • Patient satisfaction
ratings? (e.g. patient experience surveys) / • Productivity? (e.g. RVUs per
clinical session) / • Utilization or costs of care? (e.g. generic drugs,
imaging) / • Caring for chronic illness? (e.g. asthma or diabetes)
Are clinicians and staff given feedback on practice-level performance on…
• Clinical quality profiles? (e.g. HEDIS measures) / • Patient satisfaction
ratings? (e.g. patient experience surveys) / • Productivity? ( e.g. RVUs per
clinical session) / • Utilization or costs of care? (e.g. generic drugs,
imaging) / • Caring for chronic illness? (e.g. asthma or diabetes)
During the past year, did your practice site implement any new initiatives to
improve performance on…
• Clinical quality profiles? (e.g., HEDIS measures) / • Patient satisfaction
ratings? (e.g., patient experience surveys) / • Productivity? (e.g., RVUs per
clinical session) / • “Cost-efficiency” profiles? (e.g., GIC reports)
At present or within the past year, has your IPA participated in any of the
following quality demonstration programs:
13. Bridges to Excellence?
14. An IHI Quality Collaborative?
15. Pursuing Perfection?
16. Improving Chronic Illness Care (ICIC
Does your IPA participate in any other quality demonstration programs with
any organization external to yours? (If yes, what is the name of that
program?)
5. Does your IPA routinely profile the clinical quality of your physicians?
o Yes / o No
6. How long has your physician IPA routinely profiled the clinical quality of
your own physicians?
o For 1 year or less / o 2-4 years / o 5 or more years / o We do
not profile on this measure type
o Never/Don’t know / o Annually / o Quarterly / o Monthly / o
More often than monthly
“
o Never/Don’t know / o Annually / o Quarterly / o Monthly / o
More often than monthly
“
"
"
"
o Yes / o No
“
o Yes / o No
Questionnaire
NSPOII
NSPOII
Section/
question #
SH, Q26-29
SH, Q30-33
NSPOII
SH, Q34-37
Evolution
SA, Q4.d, e
PCOS-NS
S5,Q18
Questions ou items
Using a scale of 1 to 5, please tell from your own experience how effective
you think each of the following approaches is in changing physician
behavior to deliver better quality care.
26. Financial incentives
27. Peer pressure (e.g., performance reports that compare a doctor’s
performance to other doctors in the IPA)
28. Public reporting of performance results
29. System level assistance (e.g., information systems investment and
support)
Using a scale of 1 to 5 please tell how important each of the following is as
a motivator for quality improvement for your IPA.
30. Public accountability, that is, publicly available performance results?
31. Improving patient outcomes?
32. Increasing patient satisfaction?
33. Earning pay for performance incentive payments from health plans?
Using a scale of 1 to 5 please tell to what extent each of the following is a
barrier to your IPA’s quality improvement activities
34. Time
35. Money and other resources to invest in staff, training, or equipment
36. Information systems
37. Knowledge and expertise
d. At your clinic, is there anyone who ensures that the quality of medical
acts is evaluated?
e. At your clinic, is there anyone who organizes continuing medical
education activities? (Circle only one answer per statement.)
(i) Has your primary care organization implemented any quality
improvement initiatives over the past 12 months?
(ii) If yes, has your primary care organization implemented any changes in
clinical practice as a result of these quality improvement initiatives?
(iii) If yes, please briefly describe a few examples of such changes in
clinical practice.
To the best of your knowledge, within the last 2 years did the practice site
receive assistance from the following organizations for the purpose of
improving the quality of clinical care?
• A health plan / • A professional society / • An independent consultant / •
Any of the following: Baycare, HVMA, Fallon, PCHI, Lahey, PCLLC,
UMass, New England Quality Care Alliance / • An organization not named
above
1. Not Effective
2.
3. Moderately Effective
4.
5. Very Effective
1. Not important
2.
3. Somewhat important
4.
5. Very important
1. No barrier
2.
3. Moderate barrier
4.
5. Great barrier
o No / o Yes – A physician - in-charge or designated physician /
o Yes – The group physicians collectively / o Yes –
Administrator/manager / o Doesn’t apply because only 1 doctor
in the clinic
(i) o Yes / o No
(ii) o No / o Yes
o No/Don’t know
o Yes (If yes, please write name) : _____________
“
PPQCS
Q16
TransforMED PCMHC
S - Quality
Measures, Q2
Your practice is a culture of improvement if you and your staff:
o Establish core performance measures / o Collect data for
better clinical management / o Analyze the data for quality
improvement / o Map processes to identify efficiencies / o
Discuss best practices
NSPOII
SE, Q9
During the past year, did your IPA receive better contracts (for example,
better payment, preferred status) with health plans for its performance on
measurements of patient satisfaction and/or clinical quality?
o Yes / o No
85
Questionnaire
ISPCD
ISPCD
Section/
question #
Measuring
Practice
Improvement Q23
Measuring
Practice
Improvement Q24
IDCP2D - TIS
S - Structure,
Q21
NSPOII
SH, Q1-2
TransforMED PCMHC
S - Practice
Organization,
Q15
Questions ou items
Is your own clinical performance reviewed against targets at least
annually?
o Yes / o No
Do you receive information on how your own clinical performance
compares to other doctors?
o Yes, routinely / o Yes, occasionally / o No / o Not sure
Does your practice provide feedback on performance to the practice team?
(How is this done? Do they have a formal process – e.g. annual
appraisal?)
1. Does your IPA routinely profile the utilization of your physicians?
2. How long has your physician IPA routinely profiled the utilization of your
own physicians?
Does your practice offer individuals and teams opportunities for
development through:
Based on your experience, what are the 2 features of a practice site that
best enable the delivery of high-quality care?
Based on your experience, what are the 2 most important obstacles to
PPQCS
Q2
delivering high-quality care?
IPA’s investment in quality improvement, if any, have a positive financial
impact, a negative financial impact, or neither for…
18. Asthma?
NSPOII
SE, Q18-21
19. CHF?
20. Depression?
21. Diabetes?
Mesures et politiques de sécurité
S - Quality
Does the practice have a written policy on complaints?
Practice Q.
Q15
S - Quality
NATMEDCA Does the practice have a written policy on critical events investigation
management,
Practice Q.
procedures?
Q16
71. People in this practice are actively doing things to improve patient
safety.
72. Staff feel like their mistakes are held against them.
S - Patient
73. Mistakes have led to positive changes here.
TransforMED Safety, Q7174. It is just by chance that more serious mistakes don’t happen in this
PEC
79
practice.
75. Patient safety is never sacrificed to get more work done.
76. Staff worry that mistakes they make are kept in their personnel file.
PPQCS
86
Q1
o Yes / o No
o Yes / o No
o Ongoing education / o Leadership training / o Team meetings /
o Roles and responsibilities that are stimulating and rewarding /
o Shared vision and responsibility for quality of care / o Value for
the contributions of all individuals
i. ______________________________
ii._______________________________
i. ______________________________
ii.________________________________
o No investment / o Positive financial impact / o Negative
financial impact / o No impact
“
o Yes / o No
o Yes / o No
statement.
Strongly Agree
“
Questionnaire
QUALICOPC
Section/
question #
S- Patient
safety, Q24
Questions ou items
77. People in this practice openly discuss errors that happen in the
practice.
78. Staff are afraid to ask questions when something does not seem right.
79. When things get really busy, people in this practice are expected to
work faster, even if it means taking shortcuts.
Are the following safety measures applied in your practice?
• There is a list of emergency drugs that must be available
• All drugs are safely stored (not accessible to children, patients)
• Sharps are disposed of in a special container
• There are sufficient fire extinguishers
S- Patient
Has reception staff in your practice/centre been trained in First Aid?
safety, Q25
S- Patient
Could someone who is cleaning your office have a look into your patient
QUALICOPC
safety, Q26
files?
Office systems
and
Does your practice have a process for identifying adverse events and
information
ISPCD
taking follow-up action?
technology Q21
Lignes directrices et mesures de processus de soins
S - Quality
Does the practice have evidence-based protocols and / or guidelines?
Practice Q.
Q21
S - TeamTransforMED Have all the providers in your practice agreed to follow consistent
Based Care,
MHVSA
evidence-based treatment guidelines?
Q2
TransforMED S - Quality
Are you using these clinical information systems:
PCMHC
Measures, Q1
Does your practice use these checklists and reminders?
PCMHC
Measures, Q3
Do your care plans reflect:
PCMHC
Measures, Q4
Does your practice site have a system of reminders (e.g., flowsheets or
checklists) that prompt clinicians at the time of a patient visit when a
patient is due for…
• Mammograms / • Pap smears? / • Chlamydia screening? / • Colorectal
cancer screening?
PCPSS
Q6
For patient with diabetes:
• Hemoglobin A1c testing? / • Cholesterol testing? / • Eye examination? / •
Nephropathy monitoring?
For patient who had an MI, PTCA, or CABG:
• Cholesterol testing? / • Beta-blocker use?
QUALICOPC
"
o Yes / o Probably / o No
o Yes, and process works well
o Yes, but process could use improvement
o No process
o Yes / o No
o Yes / o No
o Registries / o Referral tracking / o Lab result tracking / o
Medication interaction alerts / o Allergy alerts
o Evidence-based reminders / o Preventive medicine reminders
/ o Decision support
o An updated problem list / o A current medication list / o
Patient-oriented goals and expectations
o No/Don’t know / o Yes, on paper / o Yes, electronic / o Yes,
both
"
87
Questionnaire
PCPSS
PCPSS
Section/
question #
Questions ou items
Q7
Does your practice site…
• Maintain lists of patients at high risk of disease complications or
hospitalization?
• Provide care management specifically for patients at high risk of disease
complications or hospitalization?
• Routinely assess the self-management needs of your chronically ill
patients? (e.g., by questionnaire)
o No/Don’t know / o Yes
“
Q9, 10
9. Does your practice site have a registry that creates lists of patients who
are overdue for their…
• Screening services? (e.g., Pap smears, mammograms)
• Chronic disease services? (e.g., hemoglobin A1c in diabetes; cholesterol
in coronary artery disease)
10. Does your practice site have a registry that creates lists of patients who
are out of the target range for their…
• Chronic disease laboratory values? (e.g., hemoglobin A1c over target)
• Chronic disease physical findings? (e.g., blood pressure or BMI over
target)
Do you use clinical guidelines for the treatment of the following? Please
also tick whether you think these guidelines are based on the latest
S- Quality
available scientific evidence
QUALICOPC
assurance,
• Cardiovascular diseases / • Asthma or COPD / • Depression / • Diabetes /
Q22
• Hypertension
Satisfaction du personnel et des patients
S - Practice
23. How does your practice measure clinician (MD, DO, NP, PA)
satisfaction?
BPS
Demographics
32. How does your practice measure staff satisfaction?
, Q23, 32
TransforMED BPS
TransforMED BPS
TransforMED MHVSA
NSPOII
88
S - Practice
Staffing
Demographics
, Q24, 33
S- New Model
Characteristics
, Q81
S - Patient
Centered
Care, Q11
SH, Q5-9
Has your practice made any changes based on your measurement of
clinician satisfaction?
o No / Don’t know / o Yes, on paper / o Yes, electronic / o Yes,
both
“
Use: o Yes / o No
"
Based on the latest available scientific evidence : o Yes / o
No / o Don’t know
o Suggestion box / o Survey / o Don’t measure / o Other (please
specify)
o Yes / o No
Has your practice made any changes based on your measurement of staff
satisfaction?
Monitoring and analysis of patient outcomes
o Currently use / o Considering using / o Previously used
Does your practice have any kind of formal patient feedback process in
place which evaluates the patient's experience/satisfaction?
o Yes / o No
To what extent do you believe that the majority of physicians in your IPA
would agree with each of the following statements?
5. To what extent would they agree that the IPA does a good job of
assessing patient needs and expectations?
6. To what extent would they agree that the staff promptly resolve patient
complaints?
o Strongly Disagree / o Disagree / o Neither Agree nor Disagree
/ o Agree / o Strongly Agree
“
Questionnaire
Section/
question #
Questions ou items
7. To what extent would they agree that the patients’ complaints are
studied to identify patterns and prevent the same problems from recurring?
8. To what extent would they agree that the IPA uses data from patients to
improve care?
9. To what extent would they agree that the IPA uses data on patient
expectations and/or satisfaction when developing new services?
3. Does your IPA routinely profile patient satisfaction with your own
physicians?
NSPOII
SH, Q3-4
4. How long has your physician IPA routinely profiled patient satisfaction
with your own physicians?
Does the place where you practice routinely receive and review data on
Measuring
the following aspects of your patients’ care?
Practice
ISPCD
• Clinical outcomes (e.g., percent of diabetics or asthmatics with good
Improvement control)
Q22
• Surveys of patient satisfaction and experiences with care
Évaluation externe
In the past 12 months, has the following occurred in your practice/centre?
• Inspection of medical files by health authority or insurer
• Feedback on your prescriptions or referrals by health authority or insurer
S- Quality
• Informal feedback from colleague GPs (peer review or practice visitation)
QUALICOPC
assurance,
• Investigation into the satisfaction of your patients
Q23
• Information received from community workers or local authorities about
health or welfare issues in your practice area
Is your IPA by external entities such as health insurance plans on …
1. Measures of patient satisfaction?
NSPOII
SE, Q1-3
2. Measures of clinical quality such as HEDIS?
3. Use of information technology?
BEACH - GP
Q17
Is your major practice accredited?
COMP-PC
S2,Q5
In your practice, has a medical record audit been performed during the
past two years?
IMEPHC
S7, Q1
o Yes / o No
o Yes / o No
o Yes / o No
"
o Yes / o No
“
o Yes / o No
89
5.
PRESTATION DE SERVICES ET PRATIQUES CLINIQUES
5.1
HORAIRES ET HEURES D’OUVERTURE
L’accessibilité des soins de santé pendant (et après) les heures d’ouverture de la clinique est abordée ici en termes de capacité de la
clinique à assurer la disponibilité de professionnels de la santé (services sur rendez-vous et sans rendez-vous).
Section/
Questions ou items
question #
Prestation de services et pratiques cliniques / Horaires et heures d’ouverture / Heures d’ouverture
NAMCS - PIIF
S2 - Q18g
Do you see patients in the office during the evening or on the weekends?
Please indicate the standard day, half days closed, and extra hours the practice
is open.
NATMEDCA a. Standard day (eg 8:30 – 5:00 pm)
S - Access, Q1
Practice Q.
b. Half days closed (eg Wed. pm)
c. Extra hours (eg Thursday evening or Saturday morning)
S - Opening
How many hours on an average working day is your practice/centre open for
QUALICOPC
hours, Q31
patient care?
Is it possible for patients to visit your practice/centre:
S - Opening
QUALICOPC
• After 18h00 (at least once per week)
hours, Q32
• On a weekend day (at least once per month)
PCPSS
Q21
Is your practice site regularly open to provide care on Saturdays or Sundays?
How many nights per week is your practice site open for patient visits during
PCPSS
Q22
extended evening hours?
Questionnaire
S1, Q7
Please indicate the hours during which your practice is open. (Ignore meal
breaks). On days when the practice is closed all day, please check “Closed all
day”.
IMEPHC
S9, Q2
Please indicate the hours during which your practice is open (Ignore meal
breaks). On days when the practice is closed all day, please indicate what oncall services (other than the Ontario Telephone Health Advisory System) your
practice or network provides when patients get sick. Hours of Operation
PCOS - NS
S1, Q1
Is your primary health care organization open during the following non-business
hours? (Please do not include on-call coverage.)
COMP-PC
90
o Yes / o No
a. Open____ Close ____
____ hours per working day
o Yes / o No
"
o Yes / o No
o None / o 1 / o 2 / o 3 / o 4 / o 5 or more
Monday: ____:____AM to____:____PM or o Closed all day
Tuesday: ____:____AM to____:____PM or o Closed all
day
Wednesday:____:____AM to____:____PM or o Closed all
day
Thursday: ____:____AM to____:____PM or o Closed all
day
Friday: ____:____AM to____:____PM or o Closed all day
Saturday: ____:____AM to____:____PM or o Closed all
day
Sunday: ____:____AM to____:____PM or o Closed all day
A. Weekday evenings
o No / o Yes, __ days per week from ___ to ___
B. Saturdays
o No / o Yes, from ________to _______
C. Sundays
o No / o Yes, from ________to _______
Section/
Questions ou items
question #
Prestation de services et pratiques cliniques / Horaires et heures d’ouverture / Planification des plages horaire
NAMCS - PIIF
S2 - Q29b
Does your practice set time aside for same day appointments?
S - New Model
Open-access scheduling (Under the open-access scheduling model, the practice
typically leaves 50°/o to 65% of office visit slots fee. These slots are then filled
BPS
Q70
each day based upon requests received since the end of the previous work day.)
Questionnaire
o Our practice schedules patients as needed. Please list
average wait time below
o Our practice has a manual open access scheduling
system
o Our practice has software for open access scheduling
(please describe the software) ____
o If you schedule patients as needed, please list the
average wait time: _____
TransforMED BPS
S - New Model
Characteristics,
Q89
PCPSS
Q23
CPCQ
S - Practice
Profile, Q12
Evolution
SB, Q1e-l
QUALICOPC
SAppointment
system and
waiting times,
Q34b
Do you offer a walk-in hour?
o Yes / o No
Evolution
SB, Q3
What percentage of walk-in visits to all visits do you provide at your clinic?
o 0% / o 1 to 25% / o 26 to 50% / o 51 to 75% / o 76 to
100%
IDCP2D - TIS
IDCP2D - TIS
S - Structure,
Q17
S - Structure,
Q18
Please describe the scheduling process utilized by your office.
Does your practice site have open-access scheduling (i.e., guaranteed sameday or next-day routine appointment with clinicians)?
Which of the following medical services do you offer WITHIN THE CLINIC.
• Scheduled appointments / • Walk-in care
At your clinic, …
• Do you offer services by appointment during weekends (Saturday or Sunday)?
• Do you offer services by appointment during weekday evenings (after 6:00
pm)?
• Do you offer walk-in services during weekends (Saturday or Sunday)?
• Do you offer walk-in services during weekday evenings (after 6:00 pm)?
• Do you offer services at night (between midnight and 8:00 a.m.)?
• Outside the clinic’s opening hours, do you direct patients to another available
clinic?
• Outside the clinic’s opening hours, do you direct patients to the Info-Santé help
line?
• Outside the clinic’s opening hours, do you direct patients to hospital emergency
departments?
o Yes / o No
o Mornings / o Afternoons / o Nights / o Week-ends / o
Holidays
“
o Yes / o No “
How many surgery appointments do you offer in one week? ………………..
How many emergency appointments do you offer in one week? ………………..
(are these in addition to or included in above number – Q17?)
91
Section/
Questions ou items
question #
Prestation de services et pratiques cliniques / Horaires et heures d’ouverture / Dispositions en dehors des heures d’ouverture
What are the normal after-hours arrangements for your practice?
o Practice does its own / o Co-operative with other
BEACH - GP
Q19
practices / o Deputizing service / o Other / o None
o Provides own after-hours cover / o Member of collective
NATMEDCA What after-hours arrangements does the practice have?
S - Access, Q5
after-hours service / o Sign out to after-hours service / o
Practice Q.
(Tick all that apply.)
Other
a. Do you provide after hours cover?
NATMEDCA b. If yes, how often do you provide cover on week nights (e.g. 1 in 5 nights)?
Q11a,b,c
a. o Yes / o No
PQ
c. If yes, how often do you cover at the weekend (e.g. 63 hours every 3 weeks)?
o I am always available for my patients / o I am available on
rota basis with a group of GPs / o I am not available, but
S - Out-ofWhen your practice/centre is closed, how do patients have access to (nonother GPs are available on a rotation basis / o Other
QUALICOPC
hours care,
emergency) medical services?
physicians (not GPs) provide out-of hours care / o Other
Q33
arrangements
Hours available:
On Call Services- When the practice is closed
Monday - __:__ to __:__
We offer care and advice…
Tuesday - __:__ to __:__
a. at the practice:
Wednesday - __:__ to __:__
S9, continued
Thursday - __:__ to __:__
b. through shared arrangements with other practices:
IMEPHC
from Q2 (see
Friday - __:__ to __:__
suvey form)
Saturday - __:__ to __:__
Sunday - __:__ to __:__
o Monday / o Tuesday / o Wednesday / o Thursday / o
c. We are not able to offer on call services :
Friday / o Saturday / o Sunday
A. Weekday evenings
o No / o Yes, __ days per week from ___ to ___
B. Saturdays
Does your primary health care organization provide after hours on-call coverage
PCOS - NS
S1, Q2
o No / o Yes, from ________to _______
to the population served?
C. Sundays
o No / o Yes, from ________to _______
When your clinic is closed, is there an on-call system for…
• Vulnerable patients (as defined by the RAMQ)?
o Yes / o No
• Regular patients who have a family doctor at your clinic?
Evolution
SB, Q8
“
• People who have a medical record but don’t have a family doctor at your clinic?
• People who don’t have a medical record at the clinic?
Access to Care
Does your practice have an arrangement where patients can see a doctor or
ISPCD
and Caring for
nurse if needed when the practice is closed (after-hours) without going to the
o Yes / o No
Patients - Q6
hospital emergency room or department?
Questionnaire
92
Section/
Questions ou items
question #
Prestation de services et pratiques cliniques / Horaires et heures d’ouverture / Rendez-vous
10. At your clinic, how much time is scheduled for visits for evaluation of a new
patient?
Evolution
SB, Q10, 11, 12 11. At your clinic how much time is scheduled for follow-up visits?
12. At your clinic how much time is scheduled for emergency consultations
(other than mental disorders)?
Does your clinic confirm appointments with patients a few days before scheduled
Evolution
SB, Q7
visits?
NATMEDCA S - Access, Q2
Does the practice use a booking system?
Practice Q.
S - Structure,
What is the booking interval for routine patient consultations at your practice (GP
IDCP2D - TIS
Q16
appointments)?
SAppointment
system and
QUALICOPC
What percentage of your patient consultations is by appointment?
waiting times,
Q34a
Questionnaire
(Check one only.)
o Less than 10 minutes / o 10 minutes / o 15 minutes / o 20
minutes / o 30 minutes / o Over 30 minutes
o Yes / o No
o Yes / o No
…..mins
About ______%
93
5.2
TYPES ET GAMME DE SERVICES OFFERTS
On retrouve ici une liste exhaustive des services offerts par la clinique. L’objectif de cet exercice est de brosser le portrait de la
diversité et de l’étendue des activités de soins de santé fournis en clinique.
Section/
Questions ou items
question #
Prestation de services et pratiques cliniques / Types et gamme de services offerts / Services de soutien et de consultations
During the last normal week of practice, about how many encounters of the
following type did you make with patients:
NAMCS - PIIF
S2 - Q19b
• Nursing home visits / • Other home visits / • Hospital visits / • Telephone
consults / • Internet/e-mail consults
NATMEDCA • Do practitioners in the practice make home visits?
S - Access, Q4
o Yes / o No
Practice Q.
• If yes, what is the average number of home visits made par week?
NATMEDCA a. Do you provide medical care to rest homes?
o Yes / o No
Q13a,b
PQ
b. If yes, do you claim GMS for rest home visits?
"
Please indicate approximately what number of patients are seen in a typical
S - Practice
TransforMED week in the following categories:
Source of estimates :
Demographics,
BPS
• Office Visits / • Hospital Visits / • Emergency Department / • Home Visits / •
(1=EMR, 2=billing data, 3= best guess)
Q9
Nursing Home
During a typical week, what percentage of patient visits are with…
• Physicians? / • Nurse practitioner (NPs)? / • Physician assistant (PAs)? / •
____%
Social workers? / • Diabetes educators? / • Care managers? / • Medical
PCPSS
Q18
“
assistants? / • Health coaches? / • Pharmacists? / • Others providers (e.g.,
nutritionists)?
Do any of the following health professionals employed by the practice provide
IMEPHC
S3, Q1
home visits for the practice patients?
o Yes / o No
• Nurses / • Dietician / • Nurse practitioner / • Pharmacist / • Other ___________
Does anyone at your practice provide the following services OFF-site and
specifically to your patient population?
• End of life care / • Preparation for delivery and delivery (off site) of babies / •
IMEPHC
S4, Q3
Hospital visits / • Nursing home care / • Outreach services for the vulnerable or
special needs population / • Other (please specify): ____________
Which of the following medical services do you offer within the clinic. (Please
check all that apply.)
o Never / o Sometimes / o Often
S - Practice
• Visits to nursing homes or residences for the elderly / • Home visits / • Palliative
CPCQ
“
Profile, Q 12
care / • Management of chronic diseases / • Intra-hospital care / • Psychotherapy
/ counselling / • Integrated on-call network in the area
NATMEDCA S - Access,
Does the practice provide independant nursing consultations? (Patients seen by
o Yes / o No
Practice Q.
Q10
nurse without same-day doctor consultation.)
a. Do you provide telephone consultations ni place of face-to-face consultations?
NATMEDCA Q17a,b
b. If yes, please estimate the number of hours per week for telephone
o Yes / o No
PQ
consultations?
S - Practice
Do your clients have telephone access to advice given by a doctor or a nurse
CPCQ
o Yes / o No
Profile, Q 11
linked to this clinical setting 24/7, 365 days a year (excluding info-santé)?
Evolution
SB, Q1c,d
At your clinic, …
o Yes / o No
Questionnaire
94
Section/
question #
Questions ou items
“
Evolution
SB, Q9
PCOS -NS
S1, Q3
c. Can a patient leave a message on an answering machine and get a return call
from a physician or nurse?
d. At least one doctor make home visits?
For each client group specified below, indicate if it is possible for patients to
contact a physician or a nurse by telephone during the clinic’s opening hours?
• Vulnerable patients (as defined by the RAMQ)? / • Regular patients who have a
family doctor at your clinic? / • People who have a medical record but don’t have
a family doctor at your clinic? / • People who don’t have a medical record at the
clinic?
Do patients have access to on-call services through a:
• Telephone / • Walk-in clinic / • Other (please
describe)______________________
TransforMED PCMHC
S - Patient
Experience, Q5
Questionnaire
Which of the following are you using to improve your patients’ access to care?
o Yes / o No
“
o Yes / o No
“
o Same day appointments / o Email / o Web portal for Rx,
appointments, or information / o Referral to online
resources / o Non-visit based care and support
S - Access to
Does your practice provide patients with any alternatives to the traditional
o Yes / o No
Care and
appointment like e-Visits or group visits?
Information, Q7
Practice Profile
and
In a given week, what percentage of your work time do you spend on face-to______%
ISPCD
Demographic
face contacts with patients?
Data – Q32
Prestation de services et pratiques cliniques / Types et gamme de services offerts / Services médicaux et préventifs
a. Does your practice currently recommend the human Papillomavirus (HPV)
o Yes – Skip to item 30c / o No – Go to item 30b
vaccine?
b. Does your practice plan on recommending the HPV vaccine?
o Yes – Go to item 30c / o No – Skip to item 30e
o Gardasil (quadrivalent vaccine) / o Cervarix (bivalent
S2 c. Which HPV vaccine does your practice recommend using?
NAMCS - PIIF
vaccine) / o Both /o Don’t know
Q30.a,b,c,d,e
o Females 9-12 years of age / o Females 13-26 years of
d. What age group(s) does your practice recommend patient get the HPV
age / o Females 27 years of age and older / o Males 9-12
years of age / o Males 13-26 years of age / o Males 27
vaccine?
years of age and older
TransforMED MHVSA
95
Questionnaire
Section/
question #
Questions ou items
e. Please indicate the reason(s) why your practice does NOT plan on
recommending the HPV vaccine.
NAMCS - PIIF
S2 - Q31
S -Services
provided, Q7
S -Services
provided, Q8
S -Services
provided, Q11
S - Practice
Characteristics,
Q43
TransforMED BPS
QUALICOPC
96
S - Medical
procedures
(scale), Q53
Do you offer any type of cervical cancer screening?
What screening programs with dedicated recall and follow up systems are
provided?
Does the practice provide… (Please tick all that apply.):
• Minor surgery / •Mental health services / • Group health promotion / • Formal
counseling services / • Community worker services / • Dental health services / •
Occupational medicine / • Dedicated adolescent medicine / • Dedicated older
persons care / • Sports medicine / • Emergency # accidental call out / • Other :
(please specify)
a. Does the practice provide complementary / alternative services?
b. If yes, please specify
o Not a large proportion of recommended age group in my
practice
o Concern that it encourage sexual promiscuity
o Not wanting to convince parents/patients to accept
vaccine
o Awkwardness of conversation that HPV is sexually
transmitted
o Concern about safety of the vaccine
o Concern about failure of vaccine to prevent all cervical
cancer
o Concern about thiomersal in vaccine
o Concern about decreased efficacy in population that
have been exposed to HPV (i.e., sexually active)
o Concern that the office schedule is too crowded to
accommodate additional visits
o Insurance reimbursement issues
o Up-front costs to purchase vaccineo Concern regarding
the storage and administration protocol of vaccine
o Other – Specify ___________________
o Yes / o No / o Don't know
o Cervical smear / o Diabetes / o Mammogram / o Other
(please specify)_____
o Yes / o No
"
o Yes / o No
Which of the following procedures/services are performed in your practice?
o Flexible sigmoidoscopy / o Colonoscopy / o EKG / o
Dermatologic procedures / o Vasectomy / o Colposcopy / o
Cervical Screenings/pap smears
How often are the following activities carried out in your practice population by
you (or your staff) and not by a medical specialist? (Practice population means:
people normally applying to you for primary medical care). For example, if wedge
resections are (almost) always done by you, tick the appropriate box.
• Wedge resection of ingrown toenail / • Removal of sebaceous cyst from the
hairy scalp / • Wound suturing / • Excision of warts / • Insertion of IUD / •
Removal of rusty spot from cornea / • Fundoscopy / • Joint injection / • Maxillary
(sinus) puncture / • Myringotomy of eardrum (paracentesis) / • Applying a plaster
cast / • Strapping an ankle / • Cryotherapy (warts) / • Setting up an intravenous
infusion
o (Almost) always / o Usually / o Occasionally / o Seldom /
o Never
Section/
question #
Questions ou items
NPS2010
SE, Q15
Please indicate if you OFFER the following to your patients and if this is a
SPECIFIC AREA OF FOCUS in your practice:
• Emergency medicine / • Alternative/complementary medicine / • Travel/tropical
medicine / • Cosmetic medicine / • Anesthesia / • Community medicine/public
health / • services/health promotion / • Dermatology / • Gynecology / • Liaison to
homecare / • Hospitalist care (most responsible physician for patients in hospital
to whom you do not provide care post hospital discharge) / • Housecalls / •
Infectious disease care / • Mental health care / • Psychotherapy/counseling / •
Substance abuse care / • Pain management / • Palliative medicine / •
Occupational/industrial medicine / • Rehabilitation medicine / • Sports medicine /
• Surgery / • Day surgery / • Surgical assisting / • In-patient hospital care / •
Intrapartum care - If yes, number of births attended per year : _____ / • Pre-natal
care / • Ante-natal care / • Legal/medico-legal consultations / • Other, please
specify:
o I offer
o Specific focus
"
NFPWS2001
S - Clinical
Practice Profile,
Q20
Which of the following procedures do you perform as part of your practice?
CPCQ
S - Practice
Profile, Q14
o Audiometry / o Refraction / o ECG interpretation / o
Pulmonary function testing / o Pap smears / o IUD insertion
/ o Blood tests / o D+C aspiration / o Lumbar puncture / o
Musculoskeletal (includes joint) injection / aspiration
o Casting / Splinting / o Radiology / o Vaccinations (•
Childhood, • Influenza, • Pneumococcal) / o Rectoscopy / o
Anoscopy / o Other endoscopy Please specify: / o Needle
aspiration (for diagnosis / biopsy) / o Skin biopsy / o Other
biopsy Please specify: / o Suturing / o Other minor surgery
Please specify: / o Blood (and other fluids) samples / o
Other procedures Please specify:
Questionnaire
COMP-PC
S2, Q4
IMEPHC
S4, Q2
Evolution
SB, Q16
Does your practice provide the following services on-site? (Please check one in
item)
• Nutrition counseling by a nutrition specialist or dietitian / • Family planning or
birth control services / • Alcohol or drug abuse counseling or treatment (20 min
sessions or more) / • Counseling for behavioural or mental health problems / •
Suturing for a minor laceration / • Allergy shots / • Cryotherapy / • PAP smears / •
Sigmoidoscopy / • Phlebotomy (blood sample) / • Prenatal care / • Preparation for
delivery and delivery (off site) of babies / • Splinting for a sprained ankle / •
Removal of an ingrown toenail / • ECG/EKG (Electrocardiogram) / • Spirometry /
• Other (please specify):____________
At your clinic, are the following services available?
• Strep-test / •Skin biopsy / • IUD insertion / • Musculo-skeletal
injection/aspiration / • Suture/minor surgery / • Cervical smear (Pap test)
“
o Yes / o No
“
97
Questionnaire
Section/
question #
Questions ou items
At your clinic, do any general practitioners focus MOST of their clinical activities
or specialize in the following practice field:
• Delivery attendance and follow-up? / •Women’s health (excluding obstetrical
care)? / • Mental health? / • Geriatrics? / • Child and adolescent care? / • Plastic
surgery/treatment of varicose veins? / • Obesity? / • One or more chronic
diseases in particular (diabetes, COPD, heart failure, etc.)? / • Industrial
medicine/occupational health? / • Sports medicine? / • Traveler’s health? / •
Alternative medicine (acupuncture, osteopathy, etc)? / • Other? (Specify:
_______________)
Are the following services available in the building where your clinic is located?
• Blood samples / •Radiology / • Electrocardiography / • Spirometry / •
Colonoscopy / • Bone densitometry / • Magnetic resonance / • Ultrasound /
Doppler / • Echocardiography / • Computed tomography (CT) / • Mammography
Please indicate which of the following types of services are provided by your
organization to individual patients. Please feel free to add comments to explain
any of your answers.
Type of service
• Care for an emergent but minor problem (e.g. sprained ankle, unexplained
rash) / • Non-urgent care (e.g. well woman care, chronic illness management) / •
Pre-natal maternity care / • Intrapartum care / • Postpartum care / • Mental health
services / • Behaviour change counseling about tobacco use / • Behaviour
change counseling about healthy eating / • Behaviour change counseling about
physical activity / • Other health promotion or prevention services / •
Psychosocial services (e.g. counseling advice for physical, emotional, financial
problems) / • Liaison with home care services / • Referral to and follow-up care
from specialized agencies such as hospitals, youth centers, specialists and/or
other providers (through formalized arrangements and/or agreements) / •
Rehabilitation services / • Provision of home visits / • Specialized programs
(other than outreach services) for vulnerable or special needs population groups
/ • Outreach services to vulnerable or special population groups / • Other, specify
_______________
Are maternity services provided by the practice?
• By doctor?
• By midwife?
• By nurse?
o Yes / o No
“
Evolution
SB, Q19
Evolution
SA, Q11
PCOS-NS
S1,Q5
S -Services
provided, Q9
NATMEDCA PQ
Q16
Do you undertake obstetric deliveries?
o Yes / o No
TransforMED BPS
S - Practice
Characteristics,
Q42
Indicate the type of patient care included in your practice
o Prenatal Care / o Deliver Babies / o Minor Surgery / o
Urgent/Emergent Care
98
o Yes / o No
“
o Yes / o No
Comments
“
o Yes / o No
If yes, please check all of the following which apply
o Antenatal / o Intrapartum / o Postpartum
Questionnaire
Section/
question #
Questions ou items
NFPWS2001
S - Clinical
Practice Profile,
Q21
Please describe this practice's involvement in maternity and newborn care.
o Maternity and newborn care are not part of practice.
o Shared care: Provide antenatal care (no intrapartum
care) and usually refer low risk women to:
o Another FP/GP
o An Obstetrician / Gynaecologist
o A midwife
Low-risk women are usually transferred at ___ weeks of
pregnancy.
Antenatal care is provided for approximately ___ women
per year.
o Provide intrapartum care in addition to prenatal care.
Number of births attended per year: ___ births
o Provide postpartum care (in hospital or office)
o Provide newborn care (in hospital or office)
NFPWS2001
S - Clinical
Practice Profile,
Q22
If you provide intrapartum care, please indicate which procedures you perform as
part of your obstetrical practice. (Please check all that apply.)
o Vacuum extractions / o Low forceps / o Mid-forceps and
rotations / o Cesarean sections (primary surgeon)
SB, Q18
In your clinic, do any general practitioners provide follow-up for…
a. Pregnant women?
1. If yes, do they attend delivery?
b. Children aged 5 years or less?
2. If yes, approximately what percentage of your clinic’s clientele does this group
represent?
Evolution
CPCQ
S - Practice
Profile, Q13
Please describe this practice's involvement in maternity and newborn care.
o Yes / o No
18.2 ____%
o Maternity and newborn care are not part of practice / o
Shared care: Provide antenatal care (no intrapartum care)
and usually refer low risk women / o Provide intrapartum
care in addition to prenatal care
99
5.3
GESTION DE MALADIES SPÉCIFIQUES
Cette catégorie comprend les détails au sujet des services fournis pour la prévention, le dépistage et le traitement de certains types
de problèmes particuliers. Des programmes spéciaux, comme ceux portant sur la gestion des problèmes de santé mentale, de
dépendances et d’autres maladies chroniques, sont documentés ici.
Section/
Questions ou items
question #
Prestation de services et pratiques cliniques / Gestion de maladies spécifiques / Prévention et dépistage
S - Prevention
and health
When do you, or your staff, measure blood pressure? (More than one answer
QUALICOPC
education,
possible.)
Q54a
S - Prevention
and health
When do you, or your staff, measure blood cholesterol level? (More than one
QUALICOPC
education,
answer possible.)
Q54b
S - Prevention
and health
When do you, or your staff, carry out cervical smears for cancer screening?
QUALICOPC
education,
(More than one answer possible.)
Q54c
To what extent are you involved in health education as regards smoking, eating
S - Prevention
and drinking habits? (More than one answer possible)
QUALICOPC
and health
• Smoking / • Eating / • Problematic use of alcohol / • Physical exercise
education, Q55
Are you or your practice staff involved in the following activities?
• Intrapartum care / • Routine antenatal care / • Immunisation of children (as part
S - Prevention
of a programme) / • Paediatric surveillance of children under 4 years / • Family
QUALICOPC
and health
planning/contraception / • TB screening (as part of a programme) / • Influenza
education, Q56
vaccination (as part of a programme) / • Palliative care
Does your IPA routinely administer a health risk assessment (HRA) protocol or
questionnaire directly to patients to identify those who may benefit from
NSPOII
SG, Q1
counseling or other interventions to reduce their risk factors (do not include
health history questionnaires)?
NSPOII
SG, Q2
Are the HRA questionnaire results given to the patient’s physician?
Are the HRA questionnaire results routinely used by your IPA to contact patients
NSPOII
SG, Q3
who are considered to be at risk?
Does your IPA routinely send reminders directly…
4. To women over the age of 50 regarding mammograms?
NSPOII
SG, Q4-6
5. To high risk patients regarding flu shots?
6. To patients with diabetes regarding eye exams?
Questionnaire
100
o In connection with relevant clinical conditions / o On
request / o Routinely in surgery contacts with adults
(regardless of the reason for visit) / o In adults when invited
for this purpose
request / o Routinely in surgery contacts with adults
(regardless of the reason for visit)/ In adults when invited
for this purpose / o No such measures
request / o Routinely in surgery contacts with at risk
females / o n women when invited for this purpose / o No
such screening
o Not involved / o In connection with normal patient
contacts / o In group sessions or special programmes
o Involved / o Not involved
“
o Yes / o No
o Yes / o No
o Yes / o No
o Yes / o No
“
Questionnaire
Section/
question #
Questions ou items
Does your IPA offer patients an ongoing and systematic health promotion
program in…
7. Nutrition?
8. Weight loss or management?
9. Physical activity?
10. STD prevention?
11. Smoking cessation?
Are the following vaccination services offered at your clinic?
• Childhood vaccination? / • Influenza (seasonal flu) vaccination?
Please describe your practice's use of health risk assessment (HRA) protocols or
questionnaires to identify patients who may benefit from counseling or other
interventions in the following categories. (Check all that apply.)
65. Please describe your practice's use of nurses or health educators, within
your practice, for individual counseling in the following categories. (Check all that
apply.)
66. Please describe your practice's use of group counseling activities within your
practice for your patients in the following categories. (Check all that apply.)
Does the practice do community health screenings (e.g. schools, shopping malls,
and service clubs) or health fairs; give lectures or workshops at schools or other
community gatherings?
Please indicate how frequently you provide the following preventive services at
appropriate intervals to patients for whom they are indicated.
• Obtain history of tobacco use / • Smoking cessation counselling / interventions /
• Counselling about breast feeding / • Counselling about periconceptual folic acid
supplementation / • Clinical breast examination for women aged 50-69 / •
Mammography for women aged 50-69 / • Pap smears / • Childhood immunization
(DPT, HiB, MMR) / • Counselling on safe sex practices / • Counselling about
regular physical activity / • Blood pressure screening / • Influenza immunization
for the elderly / • Use outreach strategies (e.g., mail / telephone reminder) for
influenza immunization
NSPOII
SG, Q7-11
Evolution
SB, Q17
TransforMED BPS
S - New Model
Characteristics,
Q64
TransforMED BPS
S - New Model
Characteristics,
Q65, 66
TransforMED BPS
S - New Model
Characteristics,
Q68
NFPWS2001
S - Clinical
Practice Profile,
Q23
NFPWS2001
S - Topics of
current interest,
Q41
If you required educational information on hepatitis C / HIV topics, what topics
would be most useful to you?
S - Topics of
current interest,
Q42
Please indicate how frequently you perform each of the following as part of your
regular practice:
• Ask patients about their physical activity levels
• Assess patient fitness as part of a physical exam or through a fitness test
• Refer patients to other professionals for fitness assessment or appraisal
• Provide patients with verbal directions for a physical activity program
• Provide patients with written directions for a physical activity program
NFPWS2001
o Yes / o No
“
o Yes / o No
“
o Tobacco Use / o Eating habits/Patterns / o Physical
Activity / o Alcohol Use
o Tobacco Use / o Eating habits/Patterns / o Alcohol Use /
o Asthma Management / o Physical Activity / o Diabetes
Management
o Yes / o No
o If yes, approximately how many in the past 12 months?
______
o Very frequently / o Frequently / o Occasionally / o Very
rarely / o No applicable patients
“
o Very frequently / o Frequently / o Occasionally / o Very
rarely / o Never
"
101
Questionnaire
Section/
question #
Questions ou items
Does your practice provide counseling for the following types of issues on site?
• Tobacco use / • Unhealthy eating habits / • Obesity / • Physical inactivity / •
o YES -as required on an individual basis by: Primary care
Chronic disease related issues / • Medication / • Family conflicts / • Home safety / provider / o YES -as required on an individual basis by:
IMEPHC
S4, Q4
• Nutrition counseling by a nutrition specialist or dietitian / • Family planning or
Other HP / o YES -we offer a program in that area (e.g.
birth control services / • Alcohol or drug abuse counseling or treatment (20 min
group sessions) / o NO / o Not Sure/Don’t Know
sessions or more) / • Counseling for behavioural or mental health problems
Prestation de services et pratiques cliniques / Gestion de maladies spécifiques / Gestion des maladies chroniques
S - New Model
If your practice uses a registry to track patients with specific conditions, please
TransforMED o Diabetes / o Hypertension / o Cancer / o Asthma / o High
Characteristics,
indicate for which of the following conditions a registry is used. (Check all that
BPS
Cholesterol / o Coronary Artery Disease (CAD)
Q63
apply.)
To what extent are you involved in the treatment and follow-up of patients in your
practice population with the following diagnoses (“practice population” means:
people who normally apply to you for primary medical care)?
S - Disease
• Hyperthyroidism / • Chronic bronchitis / • Hordeolum (Stye) / • Peptic ulcer / •
o (Almost) always / o Usually / o Occasionally / o Seldom /
QUALICOPC
managemant
Herniated disc lesion / • Acute cerebro-vascular accident / • Congestive heart
o Never
(scale), Q51
failure / • Pneumonia / • Peritonsilar abscess / • Ulcerative colitis / • Salpingitis / •
Concussion of the brain / • Parkinson’s disease / • Uncomplicated diabetes type
II / • Rheumatoid arthritis / • Depression / • Myocardial infarction
You may choose more than one response for each
Does your practice site have specially trained non-physician staff who help
question:
patients better manage their…
o No / Don’t know / o Yes, Nurse Practitioner (NP) / o Yes,
PCPSS
Q11
• Asthma / • Diabetes / • Coronary artery disease / • Depression / • Obesity / •
Physician Assistant (PA) / o Yes, Registred Nurse (RN) / o
Recent discharge from a hospital / • Other conditions :______________
Yes, Medical Assistant (MA) / o Yes, other
Do physicians in your Independent Practice Association (IPA) routinely treat
patients for the following diseases? We are not asking whether your physicians
see patients who have these diseases, but rather whether they routinely treat
o Yes / o No / o Don’t know / o Refuse
that particular disease.
NSPOII
SA, Q3-6
3. Asthma?
“
4. Congestive heart failure, or CHF?
5. Depression?
6. Diabetes?
• Does your IPA maintain an electronic registry? o Yes / o
No
For each question, you can choose one or more of the responses.
• Does your IPA maintain a list of patients? o Yes / o No
1. For a majority of your patients with asthma...
• Does a Physician-Hospital Organization (PHO) provide
2. For a majority of your patients with CHF…
NSPOII
SC, Q1-4
you with a patient list? o Yes / o No
3. For a majority of your patients with depression…
• Does one or more health plans provide you with a patient
4. For a majority of your patients with diabetes….
list? o Yes / o No
"
102
Questionnaire
Section/
question #
NSPOII
SC, Q17-20
SC, Q21-24
NSPOII
SC, Q41-44
SC, Q45-48
NPS2010
SK, Q31a
NPS2010
SK, Q31b
IDCP2D - TIS
S - Structure,
Q19
IDCP2D - TIS
S - Structure,
Q23 a.-a.x.
Questions ou items
Does your IPA routinely send reminders for preventive or follow-up care directly
to a majority of patients with… (Q17-20)
Does a PHO routinely send reminders for preventive or follow-up care directly to
a majority of patients with… (Q21-24)
17./21. Asthma?
18./22. Congestive heart failure (CHF)?
19./23. Depression?
20./24. Diabetes?
We are also interested in whether your IPA uses nurse care managers. By
"nurse care manager" we mean a nurse whose primary job is to coordinate and
improve the quality of care for patients with chronic diseases. We are not asking
about nurses whose main task is inpatient utilization management – e.g. getting
patients out of the hospital at the appropriate time.
Does your IPA provide nurse care managers for patients with severe… (Q41-44)
Does a PHO provide nurse care managers for your IPA’s patients with severe…
(Q45-48)
41./45. Asthma?
43./47. Depression?
44./48. Diabetes?
Do you have summary information on your patient population with chronic
diseases (e.g., percent of diabetes patients due for an eye exam)?
If no, would you find these useful?
Do you typically use a flow sheet or checklist for chronic diseases?
If no, would you find these useful?
Does your practice use guidelines for chronic diseases?
a. If yes: which guidelines?
Does your practice have a diabetes clinic?
a. If yes: Does this sit within a more general structure of chronic disease
management clinics? (Yes or No)
a.i. If yes:
Describe the structure of care delivery within these management clinics both in
general and if anything is different in relation to diabetes care:
a.ii. Who runs the diabetes/chronic disease clinics? – What does this person do?
Any admin/clerical support (Yes or No) – if yes, who and what do they do?
a.iii. Is there a GP available during the clinics? (Yes or No)
If yes:
o Does a specific GP take a lead for diabetes (if so – which GP) or do patients
see any or their own GP? (Yes or No)
o Do patients see the GP on the day of their clinic/review visit – routinely or on a
“if necessary” basis?
a.iv. Patient recall intervals/appointment system – who does this? How often
patients recalled? (e.g. 3m, 6m, 12m, other)
a.v. What is the booking interval for annual review/diabetes review patients (how
long is the appointment and who do they see – e.g. 30 min appointment might be
20 mins with nurse and 10 mins with Dr)?
o Yes / o No
“
o Yes / o No
“
o Yes / o No
"
o Yes / o No
"
o Yes / o No
a. o National / o Local
o Yes / o No
103
Questionnaire
Section/
question #
Questions ou items
a.vi. Chasing up non-attenders - who does this? Procedure/how often?
a.vii. Referral policies/procedures – formal or informal.
What they do for newly diagnosed patients – e.g. longer 1st review, etc., refer
for education / dietician, etc.
What procedure do they have for management of patients on insulin? Do they
initiate insulin at the practice or is this done following referral to Secondary Care?
a.viii. Provision of patient education:
What kind of education do they provide for patients?
Anything special for newly diagnosed patients?
a.ix. Do they use monitoring aids – e.g. patient diaries, blood or urine testing
kits?
a.x. Anything else ?
24. Does your practice have a GP(s) or nurse(s) with a specialist interest in
diabetes – has anyone had specialist training? What does the specialist do?
Describe role in management of patients with diabetes – e.g. manage medication
(prescribe), initiate insulin etc. What training have they had (formal and
informal)? Is training on-going? Is training compulsory or sought out by individual
health professional?
25. Any other information you think may be helpful to us:
IDCP2D - TIS
S - Structure,
Q24-25
TransforMED BPS
S - New Model
Characteristics,
Q77
NFPWS2001
S - Topics of
current interest,
Q39
Please indicate the type of HIV/AIDS care you provide:
NFPWS2001
S - Topics of
current interest,
Q40
Please indicate the type of hepatitis C care you provide.
Evolution
SB, Q13
Evolution
SB, Q15
104
Chronic Disease Management (Team-based consultations concerning diet,
maintenance of medications, coordination of care, etc.)
At your clinic, do you offer systematic patient management and follow-up
services for patients who have the following chronic diseases:
• Diabetes? / • Chronic obstructive pulmonary disease (COPD)? / • Heart failure?
/ • Asthma? / • Arthritis? / • Mental disorders?
At your clinic, for follow-up of people with chronic illnesses (e.g. COPD, diabetes,
heart failure, etc.) general practitioner(s)…
• Use a registry to identify and/or track care of patients
• Gp's use a tracking system to remind patients about needed visits or services
• Follow-up patients between visits by telephone
• Use published practice guidelines as the basis for their treatment plans
• Involve office staff in identifying and reminding patients in need of follow-up
care or other service
• Assist patients in setting and attaining self-management goals
Name
Role
Training
“
o Do not provide HIV/AIDS care / o Provide HIV testing and
counselling plus care for non-HIV related health needs / o
Provide ongoing basic HIV care with referral for
complications / o Provide ongoing advanced HIV care
including treatment of complication
o Do not provide care / o Provide universal testing and
counseling /o Provide selective testing and counselling
based on risk factors / o Provide testing and counselling as
part of the diagnosis of any hepatitis / o Provide care to
asymptomatic patients / o Provide care to symptomatic
patients
o Yes / o No
“
o Always / o Usually/ o Occasionally / o Rarely / o Never
“
Questionnaire
PCOS-NS
Section/
question #
S2, Q11
Questions ou items
• Refer patients to someone within your practice for education about their chronic
illness
• Refer patients to someone outside your practice for education about their
chronic illness
• Use flow sheets in medical records to track critical elements of care
Does your primary health care organization have a client/patient registry for
chronic conditions? (Please circle one answer.)
If Yes, Please describe:
S - Topics of
current interest, How many of the following do you care for in your practice?
Q38
Prestation de services et pratiques cliniques / Gestion de maladies spécifiques / Soutien à l’auto-gestion
NFPWS2001
TransforMED PCMHC
S - Patient
Experience, Q6
NSPOII
SC, Q25-28
SC, Q29-32
NSPOII
SC, Q33-36
SC, Q37-40
NPS2010
SK, Q32a
ISPCD
Access to Care
and Caring for
Patients - Q9
Does your practice support patient self-management through:
• Does your IPA make available non-physician staff (for example, health
educators and nurses) that are specially trained and designated to educate
patients in managing their illness to your patients with: (Q25-28)
• Does a PHO make available non-physician staff (for example, health educators
and nurses) that are specially trained and designated to educate patients in
managing their illness to your patients with: (Q29-32)
25./29. Asthma?
27./31. Depression?
28./32. Diabetes?
We are interested in whether your IPA provides written materials that explain to
patients the guidelines for recommended medical care for their illness - for
example, retinal screening for diabetics.
- Does your IPA provide such written materials directly to patients with… (Q3336)
- Does a PHO provide written materials directly to your patients that explain the
guidelines for recommended medical care for patients with… (Q37-40)
33./37. Asthma?
35./39. Depression?
36./40. Diabetes?
Do you give your patients with chronic diseases written instructions about how to
manage their own care at home? (e.g., instructions on what to do to control
symptoms, prevent flare-ups, or monitor their condition at home)
o Yes / o No
___ HIV/AIDS patients
___ Hepatitis C patients
o Motivational interviewing / o Shared goal-setting / o
Home monitoring (when appropriate) / o Group visits and
support groups / o Family and caregiver engagement
o Yes / o No
“
o Yes / o No
“
o Yes, routinely / o Yes, occasionally / o No / o Don't
know/Decline to answer
105
Section/
Questions ou items
question #
Prestation de services et pratiques cliniques / Gestion de maladies spécifiques / Utilisation de protocoles et de normes cliniques
Are you involved in a disease management programme based on guidelines?
(Important characteristics of a "disease management programme" are that one or
S - Disease
more specific chronic conditions or risk-factors are managed in collaboration with
QUALICOPC
management
o Yes, always / o Sometimes / o Rarely / o Never
multidisciplinary care providers, there is a systematic and coherent approach,
(scale), Q52
focuses on an active role for patients and it strives to maximize effectiveness and
to continuously improve quality of care)
First, we would like to know whether your IPA provides the majority of your
physicians with guideline-based reminders for services the patient should receive
for use at the time of seeing the patient. An example would be a pop-up within an
electronic medical record or a reminder attached to the front of the chart.
o Yes / o No
Does this happen for the IPA's patients with…
NSPOII
SC, Q5-8
“
5. Asthma?
6. Congestive heart failure (CHF)?
7. Depression?
8. Diabetes?
SC, Q52
How familiar are you with the Chronic Care Model?
NSPOII
o Very familiar / o Slightly familiar / o Not familiar
SC, Q53
How familiar are you with the rapid cycle quality improvement strategy?
NSPOII
SC, Q54
Does your IPA use the rapid cycle quality improvement strategy?
o Yes / o No
Does your IPA participate in the effort to include involvement in quality
NSPOII
SC, Q55
improvement work as a criterion for board recertification of primary care
o Yes / o No
physicians?
Health plan disease management programs are effective in improving the quality
SD, Q8
of care for our patients with chronic illnesses.
o Strongly Agree / o Agree / o Neither Agree nor Disagree /
Health plan disease management programs provide our IPA's physicians with
NSPOII
SD, Q9
o Disagree / o Strongly Disagree
useful information about individual patients with chronic illnesses.
Overall we have a collaborative working relationship with health plan disease
SD, Q10
management programs.
Do you use electronic tools to manage your patients' chronic conditions?
o EMR / o Web sites / o Online CDM forms or programs / o
NPS2010
SK, Q32b
E-mail / o Other
Does your practice routinely use written evidence-based treatment guidelines to
treat the following conditions?
• Diabetes
o Yes, routinely use guidelines / o No, do not routinely use
Access to Care
• Depression
guidelines / o No guidelines available / o Not applicable, do
ISPCD
and Caring for
• Asthma or Chronic Obstructive Pulmonary Disease (COPD)
not see these patients
Patients – Q7
• Hypertension
• ADHD
Questionnaire
106
Section/
Questions ou items
question #
Prestation de services et pratiques cliniques / Gestion de maladies spécifiques / Soutien communautaire – de groupe
o Tobacco Use / o Eating habits/Patterns / o Alcohol Use /
Please describe your practice's use of referral systems for linking your patients to
S - New Model
TransforMED o Asthma Management / o Physical Activity / o Diabetes
community programs (e.g., patient education classes, support groups, and/or
Characteristics,
BPS
Management / o Which community programs:
individual counseling) in the following categories. (Check all that apply.)
Q67
______________
Group visits (A meeting of patients with similar needs that is conducted by the
S - New Model
TransforMED physician and another clinical professional, involving patient education
Characteristics,
BPS
concerning areas of common concern to the group, as well as the management
Q74
of individual health problems of group members.)
Does your IPA provide staff to help physicians implement any of the following?
49. primary care teams, by which we mean a group of physicians and other staff
who meet with each other regularly to discuss the care of a defined group of
patients and who share responsibility for their care.
o Yes / o No
50. “advanced access” or “open access” scheduling that encourages your office
NSPOII
SC, Q49-51
“
staff to offer same-day appointments to virtually all patients who want to be seen.
51. group visits in which multiple patients with chronic illness meet together with
a trained clinician to obtain routine medical care and to address educational and
psychosocial concerns.
Does your IPA provide data to your physicians on the quality of their care for
patients with… (Q9-12)
Does a PHO provide data to your IPA's individual physicians and/or to your IPA
as a whole on the quality of their care for patients with… (Q12-16)
o Yes / o No
SC, Q9-12
NSPOII
9./12. Asthma?
“
SC, Q12-16
11./14. Depression?
12./15. Diabetes?
Please indicate which of the following programs (e.g. self help groups, education
sessions or workshops) are offered by your primary health care organization to
groups of patients/clients (versus individual services). Please feel free to add
comments to explain any of your answers.
Type of service:
• Specific programs to reduce tobacco use among your practice population
• Specific programs to reduce unhealthy eating among your practice population
o Yes / o No
• Specific programs to reduce problem alcohol drinking among your practice
Comments
PCOS-NS
S1, Q6
population
“
• Specific programs to reduce physical inactivity among your practice population
• Specific programs for people with diabetes
• Specific programs for people with cardiovascular disease
• Specific programs for people with cancer
• Specific programs for people with asthma
• Other specific programs; please describe:
Questionnaire
107
Section/
Questions ou items
question #
Prestation de services et pratiques cliniques / Gestion de maladies spécifiques / Intervention en dépendance
Does your IPA have a written or formal policy regarding treatment of tobacco
dependence stating that your physicians should…
12. Implement a tobacco-user identification system in every practice?
13. Document tobacco-use status in the medical record of every patient?
14. Discuss with your IPA‘s patients who use tobacco their tobacco use,
NSPOII
SG, Q12-15
including advising them to quit?
15. Provide information to your IPA’s patients about methods and strategies to
quit, and/or giving them information about medications to aid in smoking
cessation?
Does your IPA have designated staff to coordinate and provide tobacco
NSPOII
SG, Q16
dependence treatments?
Does your IPA receive financial incentives from Health Maintenance
NSPOII
SG, Q17
Organizations (HMOs) to improve performance on HEDIS smoking measures?
Does your IPA evaluate the degree to which physicians provide smoking
NSPOII
SG, Q18
cessation interventions?
Has your IPA used the 2000 Clinical Practice Guideline for Treating Tobacco
NSPOII
SG, Q19
Use and Dependence published by the Public Health Service (PHS) to improve
the way in which your IPA provides smoking cessation services?
Questionnaire
108
o Yes / o No
“
o Yes / o No
o Yes / o No
o Yes / o No
o Yes / o No
5.4
DEGRÉ D’INTÉGRATION
L’importance de l’échange d’information, de la collaboration, de la coordination et de l’intégralité dans l’adaptation du traitement au
patient tout au long des soins qui lui sont prodigués.
« L’échange d’information » renvoie au niveau de communication entre les intervenants tout au long des soins prodigués au patient.
Le terme « collaboration » renvoie spécifiquement à l’importance du travail d’équipe entre les omnipraticiens, les spécialistes et les
autres professionnels de la santé afin d’offrir des soins optimaux aux patients.
La « coordination » concerne la prestation et l’organisation d’une combinaison de services et d’information grâce auxquels les
intervenants peuvent répondre aux besoins des patients en matière de santé.
L’« intégralité » est la caractéristique d’une offre de services qui répond à une vaste gamme de besoins des patients en matière de
santé tout au long de leurs expérience de soins.
Section/
Questions ou items
question #
Prestation de service et pratiques cliniques / Degré d’intégration / Échange d’information
S- Patient
If new patients enter your practice, do you normally receive their medical records
QUALICOPC
turnover, Q36
from their previous doctor?
STo what extent do you use referral letters (including details on provisional
QUALICOPC
Collaboration,
diagnosis and possible test results) when you refer patients to a medical
Q47
specialist?
STo what extent do medical specialists inform you after they have finished the
QUALICOPC
Collaboration,
treatment or diagnostics of your patients?
Q48
SAfter a patient has been discharged, how long does it take to receive a full
QUALICOPC
Collaboration,
discharge report from the hospital?
Q49
When your patient has been seen by a specialist or consultant, how often does
Teams and Care
the following occur?
ISPCD
Coordination • You receive a report back from the specialist with all relevant health information
Q13
• The information transfer is timely (i.e., available when it is needed)
After your patient has been discharged from the hospital, on average, how long
Teams and Care does it take before you receive the information you need to continue managing
ISPCD
Coordination –
the patient, including recommended follow-up care?
Q14
How do you usually receive this information?
Questionnaire
NAMCS EMRS
Q21
Do you exchange patient clinical summaries electronically with any other
providers?
NAMCS EMRS
Q21a
How do you electronically send or receive patient clinical summaries?
o Yes, always or usually / o Only occasionally / o Rarely or
never
o I send letters for all referred patients / o I use letters for
most referred patients / o I use letters for a minority of
referred patients / o I seldom or never use referral letters
o (Almost) Always / o Usually / o Occasionally / o Seldom or
never
o 1-4 days / o 5-14 days / o 15-30 days / o More than 30
days / o I rarely or never receive a discharge report / o Don’t
know
o Always / o Often / o Sometimes / o Rarely / o Never
o Less than 48 hours / o 2 – 4 days / o 5 – 14 days / o 15 –
30 days / o More than 30 days / o Rarely or never receive
adequate report
o Fax / o Mail / o Email / o Remote access / o Other
o Yes, send summaries only / o Yes, receive summaries
only / o Yes, send and receive summaries / o No / o
Unknown
o Through EMR/EHR vendor / o Through hospital-based
system / o Through Health Information Organization or state
exchange / o Through secure email attachment / o
109
Questionnaire
Section/
question #
Questions ou items
Other/Unknown
PCPSS
Q8
PCPSS
Q12
Do the clinicians at your practice site use a shared communication system (e.g.,
letters, phone calls) to contact patients who are due for…
• Mammograms? / • Pap smears? / • Chlamydia screening? / • Colorectal cancer
screening?
For patient with diabetes:
• Hemoglobin A1c testing? / • Cholesterol testing? / • Eye examination? / •
Nephropathy monitoring?
For patient with coronary artery disease:
• Cholesterol testing? / • Beta-blocker use?
For patient with asthma:
• Appropriate medications?
For all patients, is there system to contact patients…
• After a hospitalization? / • Who had not had an appointment in the practice for an
extended period (longer than clinically appropriate)?
In a typical week at your practice site, approximately how often is it…
• A problem to complete prior authorization requests for imaging studies? / • A
problem to identify formulary-approved medications for patients? / • A problem to
have medical records available at the time of office visit? / • A problem to track
and follow up test results? / • A problem to communicate with specialists outside
the practice?
S - Health
Information
Is your practice connected to the health care community in these important ways?
Technology,
Q13
Prestation de service et pratiques cliniques / Degré d’intégration / Collaboration
NATMEDCA Does the practice # local GP organisation undertake any of the following?
S - Access, Q6c
Practice Q.
c. Inter-sectoral case management
How many of the primary care physicians at your practice use hospitalists to
PCPSS
Q26
manage their patient while they are in a hospital?
Please indicate with whom you REGULARLY REFER or HAVE
COLLABORATIVE CARE ARRANGEMENTS (you work together to provide care
to a common group of patients, with mutually agreed upon roles and
responsibilities). (Check all that apply.)
• Other family physicians
NPS2010
SC, Q11
• Other specialists. Please specify the three main other specialist types to whom
you regularly refer patients or have a collaborative arrangement with:
• Other health care providers. Please specify the three main health care providers
to whom you regularly refer patients or have a collaborative arrangement with:
TransforMED PCMHC
Evolution
110
SB, Q23
“
o Never / o Rarely / o Sometimes / o Usually / o Always
“
o Internet access / o Quality reporting tools
o Yes / o No
o None / o Some / o Most / o All
o Refer / o Collaborate
"
1. __________________
2.__________________
3. __________________
In the building in which your clinic is located,…
• Are services offered by medical specialists?
o Yes / o No
If yes, how many different specialties are present? ____
• To what extent do the general practitioners in your clinic collaborate (exchange,
referrals) with the medical specialists located IN THE SAME BUILDING as your
clinic?
o Quite a bit / o Somewhat / o A bit / o Not at all
Questionnaire
Section/
question #
Evolution
SB, Q24
Evolution
Evolution
SB, Q27
SB, Q28
Questions ou items
To what extent do the general practitioners in your clinic collaborate (exchange,
referrals) with the medical specialists located elsewhere than in the same building
where your clinic is?
In the building in which your clinic is located,…
Are there any services offered by other health professionals (other than
physicians)?
To what degree do the doctors in your clinic collaborate (exchange, referrals) with
other health professionals located IN THE SAME BUILDING as your clinic?
To what degree do the doctors in your clinic collaborate (exchange, referrals) with
other health professionals located elsewhere than in the same building where
your clinic is?
S - New Model
Characteristics,
Team approach, where clinical staff are more involved in providing care
Q79
Prestation de service et pratiques cliniques / Degré d’intégration / Coordination et intégralité
S - Practice
Do clinicians in your practice have hospital admission and procedure privileges?
BPS
Q41
How is care coordinated among clinic professionals?
• Informal or ad hoc exchanges
• Pre-established care protocols for specific client groups or problems
Evolution
SB, Q22
• Case discussion meetings (statutory meetings)
• Continuing medical education sessions
Does your practice have…
• Agreements with community service agencies (e.g., health departments) to
PCPSS
Q13
enhance services for any of your patients?
• A referral system for linking any of your patients to community programs?
Where are your clinic’s patients sent when they need to see specialists?
• To a private specialists office
Evolution
SB, Q25
• To a hospital or hospital out-patient clinic
• To a hospital emergency room
Teams and Care
Is your practice part of a network of other practices who share resources for
ISPCD
Coordination –
managing patient care? This could include nurses.
Q12
(i) Does your primary health care organization currently coordinate patient care
with other health care organizations?
If Yes:
PCOS-NS
S4, Q16
(ii) Does your organization use standardized clinical protocols or assessment tools
to coordinate patient care?
(iii) If yes, please briefly describe a few examples.
TransforMED BPS
o Yes / o No
If yes, how many different specialties are present? ____
o All / o Some / o None
o Always / o Often / o Sometimes / o Never / o Doesn’t
apply because only 1 doctor in the clinic
o Always / o Often / o Sometimes / o Never
"
o Yes / o No
(i)
o Yes / o No
(ii)
o No / o N/A / o Yes
111
6.
RENDEMENT ET RÉSULTATS ORGANISATIONNELS
6.1
ACCESSIBILITÉ
La facilité avec laquelle une personne peut commencer à établir un contact et obtenir les soins nécessaires, de même que les délais
qui s’appliquent.
Section/
Questions ou items
question #
Rendement et résultats organisationnels / Accessibilité / Rendez-vous et listes d’attente
NAMCS - PIIF
S2 - Q29a
Roughly, what percent of your daily visits are same day appointments?
Access to Care
What proportion of your patients who request a same- or next-day appointment
ISPCD
and Caring for
can get one?
Patients – Q5
Questionnaire
____%
o Almost all (> 80%) / o Most (60-80%) / o About half
(~50%) / o Some (20-40%) / o Few (< 20%) / o Don’t know
NAMCS - PIIF
S2 - Q29c
On average, about how long does it take to get an appointment for a routine
medical exam?
o Within 1 week / o 1-2 weeks / o 3-4 weeks / o 1-2 months
/ o 3 or more months / o Do not provide routine medical
exams / o Don’t know
TransforMED MHVSA
S - Access to
Care and
Information, Q6
On average, 60 percent of each day in my practice's schedule is available for
same day appointments.
o Yes / o No
PCPSS
Q24
PCPSS
Q25
NPS2010
SD, Q14a
For a new patient, what is the approximate wait for a routine visit with a primary
care physician?
For an established patient requesting an appointment for a non-urgent issue,
what is the approximate wait?
Typically, if a patient contacts your office or is referred to you, how long would
that patient wait until the first available appointment WITH YOU OR YOUR
PRACTICE?
If a patient called for an appointment today…
• What is the next available appointment with any Family Physician or Nurse
Practitioner at the Family Health Team (FHT)?
• What is the 3rd next available appointment with any Family Physician or Nurse
Practitioner at the FHT?
In general, when a patient contacts your clinic, how long does the patient have to
wait (in days) before seeing a doctor…
• In an emergency situation?
• In a non-emergency situation?
o Less than 1 week / o 1-2 weeks / o 1-2 months / o 3-5
months / o 6 months or more
o Less than 1 week / o 1-2 weeks / o 1-2 months / o 3-5
months / o 6 months or more
Urgent: o Same day / o Days: (#) / o Unsure / o Not
applicable
Non-urgent: o Same week / o Weeks: (#) / o Unsure / o
Not applicable
IMEPHC
S11, Q2
Evolution
SB, Q6
ISPCD
Practice Profile
and
Demographic
Data – Q33
What percent of all your face-to-face patient visits during the past week do you
think could have been handled over the phone or by email?
o Less than 10% / o 10-19% / o 20-29% / o 30% or more
SB, Q5
At your clinic, when a patient has an urgent problem, can he or she be seen…
• Between scheduled appointments on the same day?
• On the same day during a time slot reserved for emergency cases (e.g. before
or after seeing your patients who have appointments)?
o Always / o Often / o Sometimes / o Never
Evolution
112
___ days
“
Section/
Questions ou items
question #
Rendement et résultats organisationnels / Accessibilité / Nouveaux patients
NAMCS - PIIF
S2 - Q28a
Are you currently accepting "new" patients into your practice?
Is your primary health care organization currently accepting new patients?
PCOS - NS
S1, Q4
(Please circle one answer.)
Questionnaire
QUALICOPC
S - Conditions
for entrance,
Q59
Which restrictions do you apply on taking new patients? (More than one answer
possible.)
NFPWS2001
S-Practice
Profile, Q11
To what extent are you accepting new patients into your MAIN practice? (Please
check all that apply.)
NPS2010
SD, Q14b
To what extent is your practice accepting new patients into your MAIN patient
care setting? (Please check only ONE.)
IMEPHC
S9, Q1
• Is anyone in your practice accepting new patients?
• If Yes, does your practice have criteria for accepting new patients
• If yes, please list these: ____________________________
Provide example: e.g. housebond, multiple chronic illneses, must be a family member of an
existing patient, very healthy….Other
CPCQ
S - Practice
Profile, Q9
Please rate the availability of family physicians accepting new patients in your
clinic.
o Yes / o No
o No restrictions (everyone is accepted)
o No new patients are taken above a maximum number
o No new patients are taken above certain age
o No new patients are taken outside geographical working
area
o I use a wait period for new patients
o Acceptance depends on patients’ medical history
o Other conditions
o No restrictions; practice is open to all new patients
o Closed, but will accept new referrals from other
physicians
o Closed, but will accept family members of current
patients
o Closed, but will accept friends of current patients
o Closed to patients within certain age ranges. Please
specify:
o Closed to patients with certain types of medical
problems. Please specify:
o Closed, but will accept patients with certain types of
medical problems. Please specify:
o Closed, but will accept patientso for other reason(s).
Please specify:
o Completely closed
o No restrictions; practice is open to all new patients
o Partially closed. Please estimate the number of new
patients you accepted into your practice in the last 12
months:
o Completely closed
o Does not apply to my practice setting
o Yes / o No
"
o Excellent / o Very Good / o Good / o Fair / o Poor
113
Questionnaire
Section/
question #
Questions ou items
Is your clinic currently accepting new patients for management and follow-up?
(Check a single answer only.)
Evolution
SB, Q2
What are these conditions?
Evolution
SB, Q4
To what patient do you offer walk-in services?
Rendement et résultats organisationnels / Accessibilité / Initiatives de soins
S - Conditions
Do you provide health care to people, when you are not remunerated for this (for
QUALICOPC
for entrance,
instance uninsured, illegal immigrants)?
Q60
Do you do the following to reduce financial obstacles to deprived patients:
• Provide free samples of medication / • Prescribe the cheapest equivalent
S - Patient
QUALICOPC
medicine / • Not charge the patient (e.g. for co-payments) / • Refer the patient to
access, Q35
low cost or free secondary health care
TransforMED
In an average week of work, for how many patients did your practice provide free
S – Practice
– Baseline
or discounted care because of limitations of the patient’s financial statuts
Demographics,
Practice
(exclude Medicaid and Medicare patients)?
Q18
Survey
In general, do you think the quality of medical care your patients receive
ISPCD
Q3
throughout the health care system has improved, has become worse, or is it
about the same as it was three years ago?
How often do you think your patients experience the following?
• Have difficulty paying for medications or other out-of-pocket costs / • Have
Access to Care
difficulty getting specialized diagnostic tests (e.g., CT imaging, mammogram,
ISPCD
and Caring for
MRI) / • Experience long waiting times to see a specialist or consultant / •
Patients – Q4
Experience long waiting times to receive treatment after diagnosis
At your practice site, for approximately what percentage of patient visits is no
PPQCS
Q28
payment expected or received (i.e., “charity” care)?
Rendement et résultats organisationnels / Accessibilité / Soutien après les heures normales de bureau
S - Access to
Do your patients have access 24 hours/day, 7 days/week, 365 days a year to
NFPWS2001
care, Q28
telephone advice from a physician or nurse associated with your practice?
Please rate your accessibility to the following on behalf of your patients.
Cancer care services / Cardiac care services / Palliative medicine services /
Anesthesia services / Operating room time / Emergency room/department
services / Critical care beds / Long-term care beds (e.g., nursing home, chronic
NPS2010
SD, Q13
care, etc.) / Hospital in-patient care on an urgent basis / Hospital care for elective
procedures / Routine diagnostic services (e.g., lab, x-rays, etc.) / Advanced
diagnostic services (e.g., MRI, CT, etc.) / Drugs and appliances / Other, please
specify:____________
114
o Our clinic accepts all new patients who ask / o Our clinic
accepts new patients BASED ON CERTAIN CONDITIONS
only. Please answer question 2.1 / o Our clinic doesn’t
accept any new patients
o Must be a family member of a followed patient at the
clinic / o Must be referred by another doctor / o Must be a
vulnerable patient (as defined by the RAMQ) / o Must be
an orphan patient / registered on an access list (e.g.
guichet d’accès) / o Other (Specify: ______________)
o All the patients that present / o Only patients that have a
medical record at the clinic (under a doctor’s name) / o
Doesn’t apply because we don’t offer walk-in services
o Yes / o Only in urgent cases / o No / o No such people
show up in my practice / o Not applicable (in this country
care for uninsured is remunerated)
o Always / o Mostly / o Rarely / o Never
"
o Improved / o Worse / o About the same
o Often / o Sometimes / o Rarely / o Never
o Yes / o No
o Excellent / o Very good / o Good / o Fair / o Poor / o Not
available / o Don't know“
Questionnaire
Section/
question #
Questions ou items
• Other specialist physicians (in general). Please indicate the top three
specialties with whom you most commonly interact, and rate their
accessibility:_____________
• Other health professionals (in general). Please indicate the top three health
professions with whom you most commonly interact, and rate their
accessibility:____________
Outside of regular office hours does your practice or network provide on-call
service over and above the Ontario Telephone Health Advisory System?
COMP-PC
S2, Q3-a,b
a. If yes, when your practice site is closed during the day (e.g. Saturday or
Sunday) and patients get sick, would someone from your practice site/network
be able to see them that day?
b. When your practice site is closed during the evening or night and patients get
sick, would someone from your practice site/network be able to see them that
evening or night?
Rendement et résultats organisationnels / Accessibilité / Sensibilité aux réalités culturelles
PCPSS
Q27
Does your practice site have on-site language interpreters?
Do one or more clinicians at your practice site speak a language other than
PCPSS
Q28
English while delivering patient care?
NPS2010
SC, Q8
What languages do you speak with your patients? (Check all that apply.)
IMEPHC
S4, Q5
COMP-PC
S2, Q8
BEACH - GP
Q6
Please indicate in which languages your organization can provide care to the
population you serve.
Does your practice site use any of the following methods to address the cultural
diversity in your patient population? (Please check one in each item.)
• Training of staff by outside instructors
• In-service programs presented by staff
• Use of culturally-sensitive materials/pamphlets (language, visual, images,
religious customs)
• Hire staff that reflect the cultural diversity
of the population served
• Use the services of translators/interpreters
• Planning of services that reflect cultural diversity
• Other (please specify) _________________
Do you conduct any of your consultations in a language other than English?
o No / o Yes (Continue to questions a. and b.)
o Yes, care and advice provided by the practice’s primary
care team members / o Yes, care and advice provided
through shared arrangements with other practices / o No /
o Not sure/Don't know / o Not applicable
o Yes, care and advice provided by the practice’s primary
care team members / o Yes, care and advice provided
through shared arrangements with other practices / o No /
o Not sure/Don't know / o Not applicable
o Yes / o No
o Yes / o No
o English / o French / o Other(s):
o English / o French / o Arabic / o Chinese / o First Nations
languages (e.g., Cree) / o German / o Greek / o Hungarian
/ o Inuit languages (e.g., Inuktituk) / o Italian / o Korean / o
Persian (Farsi) / o Polish / o Portuguese / o Punjabi / o
Spanish / o Tagalog (Filipino) / o Ukrainian / o Vietnamese
/ o Other________
o Definitely (always) / o Probably (usually) / o Probably not
(rarely) / o Definitely not (never) / o Not sure, don’t know
“
o No / o Yes 25-50% / o Yes <25% / o Yes >50%
115
Questionnaire
Section/
question #
Questions ou items
64. People in this practice believe cultural issues are important in their interaction
with patients.
65. People in this practice believe cultural issues are important in their
interactions with health professional colleagues.
66. People in this practice are comfortable caring for patients from culturally
S - Cultural
TransforMED diverse backgrounds.
Sensitivity,
PEC
67. People in this practice are comfortable working with health care professional
Q64-69
from culturally diverse backgrounds.
68 People in this practice are aware of the factors underlying healthcare
disparities.
69. People in this practice believe this practice provide culturally sensitive care.
Rendement et résultats organisationnels / Accessibilité / Moyennes de visites médicales
During your last normal week of practice, approximatively how many office visits
NAMCS Q10
did you have at the reporting location? (A normal week would be one with a
EMRS
normal case load, with no holidays, vacations or conferences.)
Please describe patient visits for your practice. (Please provide a numerical
response)
S - Patient
What is the approximate number of patient visits per clinician per year at this
practice?
BPS
Q11
Source of estimates:
TransforMED Please give your best estimate on the monthly average of patient visits for the
Q19
FS
practice during the last 12 months?
Between 2005 and 2006, to the best of your knowledge what was the
PPQCS
Q35
approximate change in the total number of patient visits for your practice (i.e.,
approximate change in total RVUs for the year)?
PCPSS
Q35
During 2010, approximately how many patients received primary care from
practice site?
NPS2010
SD, Q14d
Please estimate the number of patients you see in a TYPICAL WEEK,
EXCLUDING patient visits while you are on-call (on-call is defined as time
outside of regularly scheduled activity during which you are available to patients):
NATMEDCA PQ
Q15
Average number of day-time patients per week
ISPCD
Practice Profile
and
Demographic
Data - Q31
About how many patients do you see in a typical week of practice? (Your best
estimate will do.)
116
each statement.
Strongly Agree
“
______ office visits
o Decrease: o >5% / o 3-5% / o 1-3%
o No change
o Increase: o 1-3% / o 3-5% / o >5%
Please count each patient only once, no matter how much
care he or she received.
_______= number of patients or o Don’t know
Number of patients you see per week: _____ patients
6.2
FONCTIONNEMENT ET CLIMAT
Cette catégorie regroupe les éléments liés au climat organisationnel en ce qui concerne l’interaction et la satisfaction de tous les
intervenants d’une clinique.
Section/
Questions ou items
question #
Rendement et résultats organisationnels / Fonctionnement et climat / Cohésion d’équipe et partage d’idées
Please indicate how strongly you agree or disagree with each statement :
S - Heedfull
10. People in this practice understand how their jobs fit into the rest of the
TransforMED Interactions,
PEC
practice.
Q10-11
11. People are aware of how their actions affect others in this practice.
13. Most people in this practice are willing to change how they do things in
S - Respectful
TransforMED response to feedback from others.
Interaction,
PEC
14. Opinions are valued by others in this practice.
Q13-15
15. People in this practice are comfortable telling others what they really think.
17. Everybody in this practice tends to think the same about important issues.
18. People in this practice actively seek out the opinion of others.
TransforMED S - Diversity,
19. This practice encourages everyone (front office staff, clinical staff, nurses,
PEC
Q17-20
and clinicians) to share ideas.
20. People in this practice are able to disagree but still get along with each other.
1. When there is a conflict in this practice, the people involved usually talk it out
Sand resolve the problem successfully
SOAPC
Communication,
2. Our staff has constructive work relationships
Q1-4
3. There is often tension between people in this practice
4. The staff and clinicians in this practice operate as a real team
5. This practice encourages staff input for making changes and improvements
6. This practice encourages nursing and clinical staff input for making changes
and improvements
7. All of the staff participates in important decisions about the clinical operation
S - Decision
8. Practice leadership discourages nursing staff from taking initiative
SOAPC
making, Q5-12
9. This is a very hierarchical organization; decisions are made at the top with little
input from those doing the work
10. The leadership in this practice is available for consultation on problems
11. The practice defines success as teamwork and concern for people
12. Staff are involved in developing plans for improving quality
To what extent do you believe that the majority of the physicians in your IPA
would agree with each of the following four statements?
1. To what extent would they agree that the IPA is a lot like an extended family
where people are warm, caring, and loyal; interested in developing each other’s
NSPOII
SH, Q1-4
potential; and with a fair distribution of rewards?
2. To what extent would they agree that the IPA is dynamic with people willing to
try new things; an emphasis on being first; an emphasis on growth; with the most
Questionnaire
o Strongly Disagree / o Disagree / o Neutral / o Agree / o
Strongly Agree
“
Strongly Agree
“
Strongly Agree
“
Strongly Agree
“
Strongly Agree
“
o Strongly Disagree / o Disagree / o Neither Agree nor
Disagree / o Agree / o Strongly Agree
“
117
Questionnaire
Section/
question #
IDCP2D
S1, Q1
IDCP2D
S1, Q2
IDCP2D
S1, Q3
IDCP2D
S1, Q5
IDCP2D
S1, Q6
118
Questions ou items
innovative ideas and actions being the most rewarded?
3. To what extent would they agree that the IPA is very formalized and structured
with an emphasis on rules and regulations, and maintaining stability; and with
rewards based mostly on one’s rank or position within the organization?
4. To what extent would they agree that the IPA is very task-oriented and
achievement-oriented with leaders helping people meet the organization’s goals
and objectives and with rewards primarily based on the achievement of those
goals and objectives?
Generally, in this practice …
• We have a 'We are in it together' attitude
• People keep each other informed about work- related issues in the primary care
team
• People feel understood and accepted by each other
• There are real attempts to share information throughout the team
• People in this team are always searching for fresh, new ways of looking at
problems
• We take the time needed to develop new ideas
• People in the team co-operate in order to help develop and apply new ideas
• How far are you in agreement with your team’s objectives?
• To what extent do you think your team's objectives are clearly understood by
other members of the team?
• To what extent do you think your team's objectives can actually be achieved?
• How worthwhile do you think these objectives are to the team?
• Are team members prepared to question the basis of what the team is doing?
• Does the team critically appraise potential weaknesses in what it is doing in
order to achieve the best possible outcome?
• Do members of the team build on each other's ideas in order to achieve the
best possible outcome?
In this General Practice …
• Primary care team members consider your viewpoint.
• Primary care team members are able to suppress personal biases.
• Primary care team members provide you with timely feedback about a decision
and its implications.
• Primary care team members treat you with kindness and consideration.
• Primary care team members show concern for your rights as a clinician.
• Primary care team members take steps to deal with you in a truthful manner.
• Primary care team members consider your viewpoint.
Within my primary care team, team members …
• Help each other out if someone falls behind in his/her work.
• Are willing to share their expertise with other members of the team
• Try to act as peacemakers when other team members have disagreements
• Take steps to try prevent problems with other team members
• Are willing give their time to help team members who have work related
problems
Strongly disagree
1
2
3
Not At All
1
2
3
Strongly agree
5
6
7
4
4
5
To a very little extent
1
2
3
4
Completely
6
7
To a very great extent
5
6
7
Strongly disagree
1
2
3
4
Strongly agree
5
6
7
Strongly disagree
1
2
3
4
Strongly agree
5
6
7
Questionnaire
Section/
question #
CPORC
SOrganizational
Conflicts and
Politics Q1,3,4
TransforMED PEC
S - Social and
Task
Interaction,
Q25-26
Questions ou items
• "Touch base" with other team members before initiating actions that may affect
them
• Encourage each other when someone is down
• Provide constructive suggestions about how the team can improve in
effectiveness
• Are willing to risk disapproval to express their beliefs about what is best for the
team
• Attend and actively participate in team meetings
• Always focus on what is wrong with our situation, rather than the positive side
• Consume a lot of time complaining about trivial matters
• Always find faults with what other team members are doing
1. Mutual trust and cooperation among nursing staff in our unit is strong
(reversed item).
3. The climate in our unit is mainly characterized by conflicts and disputes.
4. Staff frustration is common in our unit.
25. Staff rarely get together to talk about their work.
26. People in this practice regularly talk about their personal lives.
Does your primary health care organization have a collaborative practice
agreement (e.g. description of roles, accountabilities, etc.) for the primary health
care team?
PCOS-NS
S4, Q13
If Yes, please briefly describe your collaborative practice arrangement (e.g., how
many and what type of providers)?
Do the members of your primary health care team use any of the following
mechanisms to support collaboration within the team? (Please feel free to add
comments to explain any of your answers.)
Mechanism
• Regular team meetings for organizational administration
PCOS-NS
S4, Q14
• Regular team meetings for case management
• Joint goal setting
• Shared vision for the primary care organization
• Team building sessions or workshops
• Other; please describe:
Rendement et résultats organisationnels / Fonctionnement et climat / Bien-être du personnel
47. Most of the people who work in this practice seem to enjoy their work.
48. Working in this practice is stressful.
S - Work
49. Work expectations are clear.
EnvironmentTransforMED 50. People have what they need to do their work well.
General, Q47PEC
51. People receive frequent and helpful feedback about their work.
52
52. People in this practice believe they have many opportunities to grow in their
work.
Strongly disagree
1
2
3
4
Strongly agree
5
6
7
Strongly Agree
“
o Yes / o No
o Yes / o No
Comment
“
o Strongly Disagree / o Disagree/ o Neutral / o Agree / o
Strongly Agree
“
119
Questionnaire
Section/
question #
SOAPC
SStress/chaos
Q13-18
IDCP2D
S1, Q7
IDCP2D
S1, Q9
ISPCD
Q2
IDCP2D
S1, Q10
IDCP2D
S1, Q11
120
Questions ou items
13. It’s hard to make any changes in this practice because we are so busy
seeing patients
14. The staff members of this practice very frequently feel overwhelmed by the
work demands
15. The clinicians in this practice very frequently feel overwhelmed by the work
demands
16. Practice experienced as ‘‘stressful’’
17. This practice is almost always in chaos
18. Things have been changing so fast in our practice that it is hard to keep up
with what is going on
Generally ...
• My job allows me to make a lot of decisions on my own
• I have a lot of say about what happens in my job
• In my job, I have very little freedom to decide how I do my work
• My job requires me to be creative
• My job involves a lot of repetitive tasks
• My job requires a high level of knowledge and skills
• My job requires that I learn new things
• I get to do a variety of different clinical tasks in my job
• I have an opportunity to develop my own special abilities
• My job requires working very fast
• My job requires working very hard
• I have to do an excessive amount of work
• I have enough time to get the job done
Have you recently …
• Been able to concentrate on whatever you're doing?
• Lost much sleep over worry?
• Felt that you are playing a useful part in things?
• Felt capable of making decisions about things?
• Felt constantly under strain?
• Felt you couldn't overcome your difficulties?
• Been able to enjoy your normal day-to-day activities?
• Been able to face up to your problems?
• Been feeling unhappy and depressed?
• Been losing confidence in yourself?
• Been thinking of yourself as a worthless person?
• Been feeling reasonably happy, all things considered?
Overall, how satisfied are you with practicing medicine?
Over the PAST 12 months:
How many episodes of sickness/illness have you had that resulted in you being
absent from work?
Over the PAST 12 months:
How many days in total were you absent from work due to sickness/illness?
Strongly Agree
“
Strongly disagree
1
2
3
4
Strongly agree
5
6
7
o Much less than usual / o Same as usual / o More than
usual / o Much more than usual
o Very satisfied / o Satisfied / o Somewhat dissatisfied / o
Very dissatisfied
Number of episodes …………………
Total number of days absent …………
Questionnaire
Section/
question #
Questions ou items
IDCP2D - TIS
S - Structure,
Q14
What is the rate of staff absence due to illness or sickness within your practice
for:
• GPs? (per person)
• Nurses (employed)? (per person)
• Administrative staff? (per person)
Days absent …….
How many episodes……
“
121
6.3
VIABILITÉ ET EFFICACITÉ
La viabilité d’une clinique se mesure à sa capacité à répondre adéquatement à la demande de services, à exploiter la clinique de
façon rentable et à soutenir le développement à long terme de la clinique.
Section/
Questions ou items
question #
Rendement et résultats organisationnels / Viabilité et efficacité / Viabilité financière
S - Practice
In the past three years, has your practice experienced a:
BPS
Q56
S - Practice
TransforMED What is the approximate percentage overhead, including rent and all employee
Characteristics,
BPS
salaries (total operating costs as a % of total medical revenue)?
Q57
Questionnaire
TransforMED FS
Q4
Which of the following best describe the profitability of your practice during the
most recent 12 months?
TransforMED FS
Q5
Which of the following statements best describes your concern about the long
term financial condition of your practice?
TransforMED FS
Q6
TransforMED FS
TransforMED FS
Q7
Q8
During the most recent 12 months have any paychecks been delayed or
eliminated for any practice staff, including clinicians, due to financial constraints
on the practice?
During the most recent 12 months have any physicians received less than
expected monthly income?
During the most recent 12 months have any vendor payments been postponed
due to cash flow concerns?
TransforMED FS
Q11
When was the last time your practice gave most of your staff members a raise
(for any reason)?
TransforMED FS
Q12
In the past 12 months, has your practice:
PPQCS
Q30
Over the past 2 years, how has the overall financial situation of the practice site
changed?
PPQCS
Q36
Between 2005 and 2006, to the best of your knowledge what was the
approximate change in the clinical income of your practice?
SC, Q9
What percentage of your gross professional income goes towards running your
practice (e.g., part-time or full-time staff, leases/rent/mortgage, equipment
leasing/rental, personal benefits, vehicle costs, professional fees, malpractice
dues, other overhead expenses)?
NPS2010
122
o Large financial gain / o Small financial gain / o No change
/ o Small financial loss / o Large financial loss
o <25% / o 30% / o 40% / o 50% / o 60% / o 70% / o >70%
A. The practice made a substantial profit / B. The practice
made a small profit / C. The practice broke even / D. The
practice had a slight loss / E. The practice had a significant
loss / F. I don’t have the details
If choice “F” was selected, please explain ____________
A. No concern for the foreseeable future / B. Slight concern
/ C. Major concern
If choices “B” or “C” were selected, please explain _____
o Yes / o No
o Yes / o No
o Yes / o No
A. This year / B. Last year / C. Before last year / D. Not
sure
If choice “D” was selected, please explain. ____________
o Delayed capital expenditures / o Invested in new capital
expenditures / o Taken on new debt for capital
expenditures / o Taken on new debt to cover operational
expenses / o None of the above / o Don’t know
o Much worse / o Somewhat worse / o No change / Don’t
know / o Somewhat better / o Much better
o Decrease: o >5% / o 3-5% / o 1-3%
o No change
o Increase: o 1-3% / o 3-5% / o >5%
____%
o Not Applicable
6.4
RÉCEPTIVITÉ AU CHANGEMENT ET CAPACITÉ D’ADAPTATION
Cette catégorie regroupe les éléments liés à la capacité de l’organisation à répondre aux besoins changeants de la population tout
en tenant compte des transitions démographiques, épidémiologiques et sanitaires de la communauté. L’aptitude de l’organisation à
répondre adéquatement aux réformes en cours figure également dans cette catégorie.
Section/
Questions ou items
question #
Rendement et résultats organisationnels / Réceptivité au changement et capacité d’adaptation
39. This practice learns from its mistakes.
S - Learning
TransforMED 40. It is hard to get things to change in this practice.
Culture, Q39PEC
41. This practice tends to be very flexible.
42
42. This practice likes to be on the cutting edge of new ideas.
91. There is a strong sense of urgency about needing to change how the
practice does its work.
92. Leadership strongly supports practice change efforts.
S - Kotter’s
93. This practice has a clear, expressible vision.
Practice
TransforMED 94. There is frequent and good communication throughout the practice about
Change
PEC
Factors, Q91how the different change initiatives are going.
95. Everyone in the practice feels able to act on the practice vision.
98
96. The practice has experienced many past changes successes.
97. The practice appears to let setbacks and problems stop its change efforts.
98. Once this practice implements a change, the change tends to stick.
1. Our unit has successfully implemented other technological changes in recent
SOrganizational
years.
2. Nursing staff in our unit have had negative experiences with technological
History of
CPORC
Change
projects in the past (reversed item).
3. Our unit is usually successful when it undertakes all types of changes.
1-3
S1. Our unit is structured to allow superiors to make changes quickly.
Organizational
2. It is easy to change procedures in our unit to meet new conditions.
CPORC
Flexibility
3. Getting anything changed in our unit is a long, time-consuming process.
1-3
1. I believe SyMOa can be successfully implemented in our unit.
S2. Managers should delay the deployment of SyMO in our unit (reversed item).
Organizational
CPORC
3. The deployment of SyMO in our unit is timely.
Readiness
4. Our unit is ready to take on this technological change.
1-4
S - Change
TransforMED Does your practice have the resources and existing infrastructure to commit to
Management,
MHVSA
planning, managing change, and training employees to adapt to change?
Q12
TransforMED - S - Application
What do you anticipate will be the most difficult challenge your practice will have
BPS
Questions, Q95 in implementing the New Model?
Questionnaire
a
Strongly Agree
“
Strongly Agree
“
Strongly disagree
1
2
3
4
Strongly agree
5
6
7
Strongly disagree
1
2
3
4
Strongly agree
5
6
7
Strongly disagree
1
2
3
4
Strongly agree
5
6
7
o Yes / o No
Un outil informatisé de planification et de suivi de la clientèle.
123
7.
CONTEXTE ORGANISATIONNEL
7.1
CARACTÉRISTIQUES DÉMOGRAPHIQUES
Cette catégorie comprend les détails liés aux caractéristiques de la population et des patients desservis par la clinique. Une
distribution est effectuée en fonction de l’âge, du sexe, du groupe ethnique et des déterminants spécifiques à la santé de la
population. Les statistiques concernant les besoins particuliers en matière de soins de santé et les questions liées à la santé
publique identifiées chez la population et les patients de la clinique font également partie de cette section.
Section/
Questions ou items
question #
Contexte organisationnel / Caractéristiques démographiques / Taille de la population de pratique
Questionnaire
TransforMED BPS
S - Practice
Demographics,
Q8
QUALICOPC
S - Your
practice, Q5
IMEPHC
IMEPHC
Size of the community in which your practice is located:
What is the (estimated) size of your practice population?
If you do not have a formal list, please estimate the number of people that
normally rely on you for primary medical care (in a joint practice: estimate your
share of the population).
Please estimate the number of patients served by your practice.
Please indicate what percentage of your population is registered / roistered.
S3, Q2
S3, Q3
S - Practice
IDCP2D - TIS
Demographics,
What is the patient list size for your practice? ……………..
Q4
NPS2010
SD, Q14c
Approximately how many patients are in your practice?
Contexte organisationnel / Caractéristiques démographiques
Please indicate the approximate percent of your patients that fall into the following
S - Patient
NATMEDCA gender categories.
Demographics,
Practice Q.
Q12
NFPWS2001
S-Practice
Profile, Q7
TransforMED BPS
S - Patient
Demographics,
Q13
PCPSS
Q15
NSPOII
SA, Q9
S - Practice
Demographics,
Q5
IDCP2D - TIS
124
o <5,000 not within 25 miles of a major city / o <5,000 within
25 miles of a major city / o 5,000 – 10,000 not within 25
miles of a major city / o 5,000 – 10,000 within 25 miles of a
major city / o 10,001 – 25,000 not within 25 miles of a major
city / o 10,001 – 25,000 within 25 miles of a major city / o
25,001 – 100,000 / o 100,001 – 500,000 / o 500,000
Number of patients: ____
________ patients
______%
_____ patients or o NA
• Female: ______%
• Male: ______%
Approximately what proportion of your patients is female?
___%
Please indicate the approximate percent of your patients that fall into the following
age categories. (Must total 100%.)
____Under 3 years / ____3-17 years / ____18-24 years /
____25-44 years / ____45-64 years / ____65-74 years /
____75 years & older
Approximately what percentage of the patients seen at your practice site are
younger than 18?
Is your IPA’s patient population mainly adult, mainly pediatric, or both?
o Less than 10% / o 10-25% / o 25-50% / o More than 50%
o Mainly adult / o Mainly pediatric / o Both
What is the % of patients on this list who are >65 years of age? ……………..
Questionnaire
TransforMED BPS
TransforMED BPS
Section/
question #
S - Patient
Demographics,
Q14
S - Patient
Demographics,
Q15
Questions ou items
Please give the approximate percentage of your patients in the following racial
categories. (Must total 100%)
____White / ____Black / African American / ____Native
American, American Indian / ____Alaska Native /
____Asian or Pacific Islander / ____Other
Please indicate the approximate percentage of your patients that are of
Hispanic/Latino ethnicity
QUALICOPC
S - Your
practice, Q6
To what extent do you think your practice population deviates from the usual
national level with respect to the following categories:
1. Elderly people (over 70 years)
2. Socially deprived people
3. Immigrants
o Below average / o Average / o Above average / o Don’t
know
"
IDCP2D - TIS
S - Practice
Demographics,
Q6
What proportions of the patients registered with your practice are:
How often do you need to use interpreters? ……………..
White British …………….. / Black British …………….. /
British Asian …………….. / British Chinese …………….. /
British Other ethnicity …………….. / Non-British
……………..
NPS2010
SE, Q16
Please indicate if you care for the following. (Please check all that apply.)
• Neonates (<1 month) / • Infants (1-12 months) / • Children (1-11 years) / •
Adolescents (12-19 years) / • Women / • Pregnant women / • Men / • Aged 65-74 /
• Aged 75 – 89 / • Aged 90 and over / • Aboriginal peoples / • Ethnic minorities / •
Recent immigrants / • People living in poverty• Homeless• Street Involved / •
Gay/Lesbian/Bisexual/Transgender / • Transient/seasonal populations / • Patients
with hypertension / • Patients with diabetes / • Patients with heart
disease/conditions / • Patients with mental illness / • Patients with obesity /•
Patients with cancer / • Patients with neurological conditions / • Patients with
respiratory conditions / • Patients with HIV/AIDS / • Patients with addictions / •
Patients with permanent physical disabilities / • Other, please specify:
o I provide health care for these patients
o This patient population represents more than 10% of my
practice population"
NPS2010
SH, Q23
Part 1
Please indicate which of the following factors are increasing the demand for your
time at work. (Check all that apply.)
S2, Q9
Does the population served by your primary health care organization have unique
cultural and/or racial characteristics or spiritual needs?
If yes:
(i) In what ways is the population unique?
PCOS-NS
(ii) Does your primary health care organization have a good understanding of how
the cultural qualities of the population impact their health care needs?
o Aging patient population / o Increasing complexity of
patient caseload / o Management of patients with chronic
diseases/conditions / o Increasing patient expectations
o No, the population is typical of the province
o Yes, the population is unique culturally
o Yes, we monitor these needs through:
o No, we need to:
125
7.2
ENVIRONNEMENT ORGANISATIONNEL ET INTÉGRATION DE LA PRATIQUE
L’environnement organisationnel définit le contexte médical. Les éléments comme la distance entre les infrastructures de soins de
santé, la présence de programmes de santé qui coordonnent les différentes institutions, la présence d’une faculté de médecine, de
même que l’existence de liens officiels ou non officiels entre les organisations au niveau de la communauté sont inclus dans cette
catégorie.
Section/
Questions ou items
question #
Contexte organisationnel / Environnement organisationnel et intégration de la pratique / Environnement organisationnel
S -Site
NATMEDCA o Large city (>500k pop.) / o City (100-500k pop.) / o Town
information,
What is the geographical location of the practice?
Practice Q.
(30-100k pop.) / o Small Town (<30k pop.)
Q24a
S –Site
b. Is the practice in a rural location?
NATMEDCA b. o Yes / o No (If no, go to question 25)
information,
c. If yes, what is the rural ranking score?
Practice Q.
c. _____ score (see enclosed rural ranking score sheet)
Q24bc
S -Site
NATMEDCA information,
Is the practice in the central business disctrict?
o Yes / o No
Practice Q.
Q25
S - Your
o Inner part of a big city / o Suburban or outskirts of big city
QUALICOPC
How would you characterise the place where you are currently practicing?
practice, Q4
(smaller) town / o Mixed urban-rural /o Rural
S - Practice
IDCP2D - TIS
Demographics,
Is the location of your practice urban or rural?
o Rural / o Urban
Q1
Practice Profile
and
ISPCD
Where is your practice located?
o City / o Suburban / o Small town / o Rural
Demographic
Data – Q35
o Small town / o Inner city / o Rural / o Urban/Suburban / o
With respect to your MAIN patient care setting specified in 4b, describe the
NPS2010
SC, Q7b
Geographically isolated/Remote / o Cannot identify a
population PRIMARILY served by you in your practice. (Please check only one.)
primary population / o Other:
o Increasing administrative workload/paperwork
o Lack of availability of local/regional physician services in
my specialty
o Lack of availability of local/regional physician services in
other specialties
SH, q23
Please indicate which of the following factors are increasing the demand for your
NPS2010
o Lack of availability of other local/regional health care
part2
time at work. (Check all that apply.)
professional services
o Medical liability concerns
o None of the above
S - Access to
Please rate the situation regarding availability of medical care services within
o No problems / o Minor problems / o Moderate problems /
NFPWS2001
care, Q24
your practice community:
o Severe problems
Questionnaire
126
Questionnaire
Section/
question #
COMP-PC
S1, Q4
IMEPHC
S2, Q1
Questions ou items
To better understand the community that you are serving, please indicate the
types of institutions/professionals servicing your community, and record the
distance from the nearest one to your practice site. (Please check for each
category.)
• Hospital (any community or secondary hospital) / • Tertiary hospital
(University/Referral Hospital) / • Nursing home (residence or long term care) / •
Walk in clinic / • Community Health Centre / • Community Care Access Centre / •
Other family practice office(s) / • Laboratory (e.g. for blood work) / • Imaging
centre (e.g. chest X-ray & Ultrasound) / • Dietitian / • Psychologist / • Social
Worker / • Physiotherapist / • Occupational Therapist / • Pharmacist / •
Chiropodist
Distance:
o In our practice
o Same Building (but not our practice)*
o < 1 km
o 1-5 km
o 6-10 km
o >10 km
o Don’t Know
*In the same building, but not offered by our practice
Programs (e.g. offered at a community centre or hospital):
• Diabetes clinic / • Smoking cessation / • Self management / • Mental health
What is the distance by road from your (main) practice building to:
o In the same building / o Less than 5 kms / o 5-10 kms / o
• The nearest GP practice (not in your group or centre)
S - Practice
11-20 kms / o More than 20 kms
QUALICOPC
• The nearest consultant/outpatient clinic (independent or part of hospital)
location, Q30
"
• The nearest general or university hospital
In the building where your clinic is located, are there other primary healthcare
Evolution
SD, Q4
o Yes / o No
medical teams or other general practitioners who are not part of your clinic?
Contexte organisationnel / Environnement organisationnel et intégration de la pratique / Intégration de la pratique
Are any of the following services located / available on the premises?
o Physiotherapist / o Psychologist / o Pathology lab /
BEACH - GP
Q18
(Includes services in the same building or within 50 meters, available on a daily
collection centre / o Imaging / o Specialist / o Other
or regular basis). (Circle all that apply.)
(specify)_________________ / o None
S - New Model
TransforMED o Currently use / o Considering using / o Previously used /
Characteristics,
Engagement with community resources or service to community
BPS
o If community resources are utilized, please specify____
Q82
S - Attention to
57. This practice is aware of community resources that are accessible to
Fitness
patients.
Landscape TransforMED 58. This practice works effectively together as a team with community
Strongly Agree
Connection to
PEC
organizations.
“
Community,
59. People in this practice are connected with community organizations that
Q57-59
serve patients.
S - Attention to
Fitness
Landscape TransforMED 61. This practice works well together with the health care system.
Strongly Agree
Connection to
PEC
62. People in this practice are connected to people in other practices.
“
Health System
Q61-62
S - Practice
TransforMED How would you describe the level of competition among practices in your local
o High competition / o Moderate competition / o Low
Information,
BPS
market?
Competition / o No competition
Q48
Does your IPA have a significant relationship with an integrated delivery system
NSPOII
SA, Q10
o Yes / o No
or a physician hospital organization?
127
Questionnaire
Section/
question #
IDCP2D - TIS
S - Structure,
Q15
COMP-PC
S1, Q8
CPCQ
S - Practice
Profile, Q15
Evolution
SB, Q20
Evolution
SB, Q29
Evolution
SB, Q30
128
Questions ou items
What additional specialist support services outside of the practice are available
to your practice in:
• Community (e.g. community-based, attached diabetes nurses, “GPwSI” (GP
with a special interest)
• Secondary care (e.g. specialist care team)
Does your practice site use any of the following activities to reach out to the
population in the community you serve? (√ - Please check one in each item.)
• Networking with provincial and local agencies involved with culturally diverse
groups
• Linkages with religious organizations/services
• Involvement with neighborhood groups/leaders
• Outreach workers
• Other (please specify)
Does the clinic have formal or operational agreements with other organizations
or institutions of the system (besides good individual relationships) in order to
provide to your patients all the services they need?
In addition to the care offered at your clinic, do any of the general practitioners in
your practice also provide care in the following settings or programs:
• Another medical clinic/private office?
• A CLSC (Other than yours, if you’re already in a CLSC) for home care
services?
• In a CLSC (Other than yours, if you’re already in a CLSC) for services other
than home care?
• The emergency room of a general and/or specialized care hospital?
• A short-term care unit of a general and specialized care hospital?
• A long-term care facility (CHSLD)?
• In medical services provided as part of a palliative care program?
• Obstetrical services in a hospital?
• Other activities identified by the Département regional de medicine générale
(DRMG)?
Does your clinic have formal or informal arrangement with other primary
healthcare clinics, CLSCs, hospitals and/or medical specialist clinics for any of
the following… Check all that apply.
• Planning services offered (on-call activities, clinic office hours, etc.)?
• Access to technical services (e.g. radiology, laboratory)?
• Exchange of resources (e.g. loan of professionals)?
• Follow-up for hospitalized patients or patients seen at the clinic?
• Others? (Specify : ___________)
If you answered “yes” to any of the choices in the preceding question, identify…
• The main primary healthcare clinic with which you have arrangements:
• The main CLSCs with which you have arrangements:
• The main hospitals with which you have arrangements:
• The main specialized with which you have arrangements:
o Definitely / o Probably / o Probably not / o Definitely not /
o Not sure, don’t know
“
o Yes / o No / o With one or more CLSCs / o With one or
more CHSGs (general care hospitals) / o With one or more
CHSLDs (long term care institutions) / o With other
institutions or organizations, specify :
o Yes / o No
“
o No
o Yes, with one or several primary healthcare clinics
o Yes, with one or several CLSC(s)
o Yes, with one or several hospital(s)
o Yes, with one or several specialized clinic(s)
"
Questionnaire
Section/
question #
Evolution
SB, Q31
Evolution
SB, Q32
Evolution
SB, Q33
PCOS-NS
S4, Q15
PCOS-NS
S4, Q17
Questions ou items
Does your clinic participate in a healthcare access network to ensure that your
clinic’s office hours are coordinated with those of other clinics (evenings,
weekends, etc.)?
Do the general practitioners at your clinic participate in a regional on-call system,
for vulnerable patients (as defined by the RAMQ)?
In your clinic, does a general practitioner (or practitioners) participate in…
• Local committees of the DRMG?
• Committees for the implementation of FMG and/or Network-Clinics?
• Committees to alleviate congestion in emergency departments?
• Committees on the Health and social service centre (CSSS) clinical project?
• Coordination of the «guichet d’accès» for the orphan patients?
• Others (Specify: ___________)?
• Does your primary health care organization have collaborative care
arrangements with other health care providers or health care organizations?
(Please circle one answer.)
• If yes, please briefly describe a few examples.
• Does your primary health care organization have formalized partnerships with
other providers or organizations beyond the health system (e.g. housing, police,
education)?
• If yes, please briefly describe a few examples.
TransforMED BPS
S - Practice
Characteristics,
Q44
Where do the majority of your patients go for routine lab work?
TransforMED BPS
S - Practice
Characteristics,
Q46
Where do the majority of your patients go for routine X-rays?
QUALICOPC
S- Equipment
in the practice,
Q28
How do you have access to laboratory facilities?
QUALICOPC
S- Equipment
in the practice,
Q29
How do you have access to X-ray facilities?
o Yes / o No
o Yes / o No
o Yes / o No
"
o Yes / o No / o N/A
o Yes / o No
o Lab located within the practice
o Lab located outside the practice but within the same
building
o Lab located away from the building where your practice is
located
o If lab work is done outside, check here if the specimen
collected onsite
o X-ray equipment located within the practice
o X-ray facility located outside the practice but within the
same building
o X-ray facility located away from the building where your
practice is located
o Within my practice/centre
o Direct access outside my practice/centre (results within
48 hours)
o Direct access outside my practice (results after 48 hours)
o Insufficient access
o Within my practice/centre
o Direct access outside my practice/centre (results within
48 hours)
o Direct access outside my practice (results after 48 hours)
o Insufficient access
129
ANNEXE 3
AUTEURS CONTACTÉS DANS LE CADRE DE
L’ÉTUDE DE REPÉRAGE
Nom
Dr William Hogg
Dr Michael Green
Dr François Schellevis
Dr William Miller
Dr Diane Rittenhouse via Kevin J. Wu
(Program Coordinator
Dr Stephen M. Shortell via Patty
Ramsay (Project director)
Dr Jako Burgers
Dr Martin P Eccles
Dr Judith Colla
Dr Bill Weeks
Dr Ann C. Bracken
Dr Mark W. Friedberg
Dr Raynald Pineault,
Dr Jeannie Haggerty
Dr Yvonne Engels
Dr Michel Wensing
Dr Björn Brog
Dr Pineault
Dr Levesque
Dr Tim Doran
Dr Diane Krause
Dr Cheryl Amoroso
Dr Jan Van Lieshout
Dr Cheryl Levitt
Dr Linda Hilts
Dan McKean
Dr Ben Crabtree
Dr Mark Harris
Institution
Outils
NIVEL (Netherlands)
Tufts University School of Medicine, Boston (United States)
COMP-PC
IMEPHC
DNSGP-2
Pas d’outil spécifique
University of California, San Francisco (United States)
School of Public Health, University of California, Berkeley (United States)
NSPOII
IQ healthcare, Radboud University Nijmegen Medical Centre (Netherlands)
Institute of health & Society, University of Newcastle (United Kingdom)
IDCP2D
Dartmouth Institute for Health Policy and Clinical Practice (United States)
Measuring Patient Safety Climate
RAND Corporation (United States)
PCPSS (2010) / PPQCS (2006)
Direction de santé publique de Montréal and McGill University, Quebec (Canada)
Continuity of primary care in Quebec
Radboud University Nijmegen Medical Centre (Netherland)
EPA, TOPAS-Europe
on Applied Quality Improvement and Research in Health Care (Germany)
Agence de la santé et des services sociaux de Montréal
Direction de santé publique
University of Manchester (United Kingdom)
University Speyer DHV, Germany
Center for Primary health Care and Equity, University of New South Wales
(Australia)
Scientific Institute for Quality of Healthcare (Netherlands)
EPA
McMaster University, Ontario (Canada)
Quality in Family Practice Books of Tools
TransforMED, Robert Wood Johnson Medical School (United States)
TransforMED assessment surveys
University of New South Wales (Australia)
The Quantitative Measurement of Organizational
Culture in Health Care
Describing models of emerging integrated primary
health care services in Australia
University of Ottawa (Canada)
Dr Tim Scott
Department of Health Sciences, University of York (United Kingdom)
Dr Claire L. Jackson
Royal Australian College of General Practitioners (Australia)
Dr Julie McDonald
Centre for Primary Health Care and Equity, UNSW (Australia)
Questionnaire organisationnel du projet Évolution
QOF
A Cross-Cultural Look at Assessment Center Practice
Validation of an instrument to measure interorganisational linkage in general practice
PCCPOHC
133
o
N de publication : 1796
e xpe rtise
conseil
inf o r m ation
f o r m ation
www.inspq.qc.ca
r ec h e r c h e
é valuation
et inno vation
collabo r ation
inter nationale
labor atoi r es
et dépistag e

Mesurer les caractéristiques organisationnelles des soins de santé

Transcription

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